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Hofmann J, Coe K, Young JD. Speed, Spectrum, and Satisfaction: Assessment of an Infectious Diseases eConsult Program. Open Forum Infect Dis 2024; 11:ofae281. [PMID: 38813258 PMCID: PMC11134458 DOI: 10.1093/ofid/ofae281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
This report examines the implementation and early functioning of a new infectious diseases (ID) eConsult program. We recorded the reasons for placing ID eConsults, time to eConsult completion, in-person clinic wait times, and referring provider satisfaction following implementation of our outpatient eConsult program. Our data suggest that this ambulatory eConsult program led to improved access to ID subspecialty care, both via eConsults directly, and by reducing clinic wait times for patients who required an in-person evaluation.
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Affiliation(s)
- Justin Hofmann
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
| | - Kelci Coe
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
| | - Jeremy D Young
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
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Babu TM, Wald A. Ancillary Care Obligations of Clinical Trial Investigators in the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:123-125. [PMID: 37812103 DOI: 10.1080/15265161.2023.2250295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
| | - Anna Wald
- >University of Washington
- Fred Hutchinson Cancer Center
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3
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Sethuram C, Helmer-Smith M, Karunananthan S, Keely E, Singh J, Liddy C. Electronic consultation in correctional facilities worldwide: a scoping review. BMJ Open 2022; 12:e055049. [PMID: 35922103 PMCID: PMC9352998 DOI: 10.1136/bmjopen-2021-055049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide an overview of the use of and evidence for eConsult in correctional facilities worldwide. DESIGN Scoping review. DATA SOURCES Three academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published between 1990 and 2020 that presented data on eConsult use in correctional facilities. The grey literature was also searched for any resources that discussed eConsult use in correctional facilities. Articles and resources were excluded if they discussed synchronous, patient-to-provider or unsecure communication. The reference lists of included articles were also hand searched. RESULTS Of the 226 records retrieved from the academic literature search and 595 from the grey literature search, 22 were included in the review. Most study populations included adult male offenders in a variety of correctional environments. These resources identified 13 unique eConsult services in six countries. Six of these services involved multiple medical specialties, while the remaining services were single specialty. The available evidence was organised into five identified themes: feasibility, cost-effectiveness, access to care, provider satisfaction and clinical impact. CONCLUSIONS This study identified evidence that the use of eConsult in correctional facilities is beneficial and avoids unnecessary transportation of offenders outside of the facilities. It is feasible, cost-effective, increases access to care, has an impact on clinical care and has high provider satisfaction. Some gaps in the literature remain, and we suggest further research on patient satisfaction, enablers and barriers to implementation, and women, youth and transgender populations in this setting to inform service providers and stakeholders. Despite some gaps, eConsult is evidently an important tool to provide timely, high-quality care to offenders.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jatinderpreet Singh
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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4
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Medford RJ, Granger M, Pickering M, Lehmann CU, Mayorga C, King H. Implementation of Outpatient Infectious Diseases E-Consults at a Safety Net Healthcare System. Open Forum Infect Dis 2022; 9:ofac341. [PMID: 35903155 PMCID: PMC9315945 DOI: 10.1093/ofid/ofac341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Safety net healthcare systems have high patient volumes and significant demands for specialty care including infectious diseases (ID) consultations. Electronic ID consults (E-consults) can lessen this burden by providing an alternative to face-to-face ID referrals and decreasing financial, time, and travel constraints on patients. This system could increase access to ID care for patients in limited-resource settings. Methods We described characteristics of all outpatient ID E-consults at Parkland Health in Dallas, Texas, from March 2018 to February 2021. We used modeling to determine which characteristics influenced conversion of E-consults to clinic visits and integrated these data into a predictive model for face-to-face conversion. Results For 725 E-consults, common E-consult topics included 118 (16%) latent tuberculosis, 116 (16%) syphilis, and 76 (10%) gastrointestinal infections. Nearly two-thirds of E-consults (456 [63%]) were requested by primary care providers. The majority (78%) were resolved without a face-to-face ID visit. Osteomyelitis, nontuberculous mycobacterial, and gastrointestinal questions frequently required face-to-face visits at rates of 65%, 49%, and 32%, respectively. Our logistic regression model predicted the need for a face-to-face visit with 80% accuracy and an area under the receiver operating characteristic curve of 0.72. Conclusions An outpatient ID E-consult program at a safety net healthcare system was an effective tool to provide timely input on common ID topics. E-consults were requested by a range of providers, and most were completed without a face-to-face visit. Predictive modeling identified important characteristics of E-consults and predicted conversion to face-to-face visits with reasonable accuracy.
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Affiliation(s)
- Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Infectious Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison Granger
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Madison Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Physical Sciences, Department of Computer Science, University of Chicago, Chicago, Illinois, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian Mayorga
- Division of Digestive and Liver Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Helen King
- Correspondence: Helen King, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9113, USA ()
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Suzuki H, Shealy SC, Throneberry K, Stenehjem E, Livorsi D. Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2021; 1:e26. [PMID: 36168461 PMCID: PMC9495641 DOI: 10.1017/ash.2021.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Stephanie C. Shealy
- Intermountain Healthcare TeleHealth Services, Murray, Utah
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah
| | - Kyle Throneberry
- Intermountain Healthcare TeleHealth Services, Murray, Utah
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Daniel Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Wingfield T, Beadsworth MB, Beeching NJ, Gould S, Mair L, Nsutebu E. An evaluation of 1 year of advice calls to a tropical and infectious disease referral Centre. Clin Med (Lond) 2021; 20:424-429. [PMID: 32675151 DOI: 10.7861/clinmed.2019-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Many secondary care departments receive external advice calls. However, systematic advice-call documentation is uncommon and evidence on call nature and burden infrequent. The Liverpool tropical and infectious disease unit (TIDU) provides specialist advice locally, regionally and nationally. We created and evaluated a recording system to document advice calls received by TIDU. METHODS An electronic advice-call recording system was created for TIDU specialist trainees to document complex, predominantly external calls. Fourteen months of advice calls were summarised, analysed and recommendations for other departments wishing to replicate this system made. RESULTS Five-hundred and ninety calls regarding 362 patients were documented. Median patient age was 44 years (interquartile range 29-56 years) and 56% were male. Sixty-nine per cent of patients discussed were referred from secondary healthcare, half from emergency or acute medicine departments; 43% of patients were returning travellers; 59% of returning travellers had undifferentiated fever, one-third of whom returned from sub-Saharan Africa; 32% of patients discussed were further reviewed at TIDU. Interim 6-month review showed good user acceptability of the system. CONCLUSIONS Implementing an advice-call recording system was feasible within TIDU. Call and follow-up burden was high with advice regarding fever in returned travellers predominating. Similar systems could improve clinical governance, patient care and service delivery in other secondary care departments.
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Affiliation(s)
- Tom Wingfield
- Liverpool School of Tropical Medicine, Liverpool, UK, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK and Karolinska Institutet, Stockholm, Sweden
| | - Mike Bj Beadsworth
- Liverpool School of Tropical Medicine, Liverpool, UK and The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Nicholas J Beeching
- Liverpool School of Tropical Medicine, Liverpool, UK and The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Susan Gould
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Luke Mair
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Emmanuel Nsutebu
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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7
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Stendahl K, Siddon AJ, Peaper DR, Hauser RG, Campbell S, Tormey CA. The Development and Implementation of a Novel Electronic Consult System by a Laboratory Medicine Service: Experience From the First 2 Years of Use. Arch Pathol Lab Med 2021; 145:75-81. [PMID: 33367659 DOI: 10.5858/arpa.2019-0267-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— A novel electronic consult (e-consult) system for a pathology and laboratory medicine service (PLMS) was implemented in 2015 at a high-complexity Veterans Administration health care facility. Consults were previously made through direct provider communication without documentation in the medical record. OBJECTIVE.— To evaluate the utilization trends of the laboratory e-consult system at the Department of Veterans Affairs Connecticut facility during the first 2 years since inception. DESIGN.— E-consultation involves pathology and laboratory medicine resident review followed by attending pathologist review and cosignature. E-consults to the pathology and laboratory medicine service from 2015 to 2017 were reviewed to record type of consult, requesting department, patient location, and turnaround time. RESULTS.— The pathology and laboratory medicine service received 351 e-consults from 2015 to 2017. The volume varied by subsection: hematology and coagulation (215 of 351; 61%), chemistry (109 of 351; 31%), blood bank (19 of 351; 6%), and microbiology/virology (8 of 351; 2%). Hematology and coagulation consults were entirely for peripheral blood smear review (215 of 215; 100%). Chemistry consults were placed for toxicology/drugs of abuse (81 of 109; 74%), test utilization (17 of 109; 16%), or nontoxicology (11 of 109; 10%). Three services placed the majority of consults: primary care (279 of 351; 80%), hematology/oncology (39 of 351; 11%), and psychiatry (27 of 351; 8%). The median turnaround time for completion of e-consults was 1.2 days. Since e-consult implementation, the mean number of consults increased from 8.6/mo in 2015 to 18.1/mo in 2017, peaking in the last quarter of analysis in 2017 with a mean of 25.3 consults/mo. CONCLUSIONS.— This novel e-consult system improved accessibility to and documentation of answers to laboratory questions and increased the visibility of the pathology and laboratory medicine service. Future goals include development of outcomes-based measures to better assess the clinical impact of e-consults.
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Affiliation(s)
- Kristin Stendahl
- Department of Pathology (Stendahl, Siddon), Yale School of Medicine, New Haven, Connecticut.,Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Alexa J Siddon
- Department of Pathology (Stendahl, Siddon), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
| | - David R Peaper
- Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ronald G Hauser
- Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sheldon Campbell
- Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher A Tormey
- Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), VA Connecticut Healthcare System, West Haven, Connecticut
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8
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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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Wood BR, Bender JA, Jackson S, Rosengaus L, Pottinger PS, Gottlieb GS, Dhanireddy S, Harrington RD, Pruzhanskaya Y, Chew LD, Scott JD. Electronic Consults for Infectious Diseases in a United States Multisite Academic Health System. Open Forum Infect Dis 2020; 7:ofaa101. [PMID: 32328507 PMCID: PMC7166117 DOI: 10.1093/ofid/ofaa101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/19/2020] [Indexed: 01/09/2023] Open
Abstract
We launched Infectious Disease electronic consultations (eConsults) in 2018. During the first 15.5 months, primary care practitioners submitted 328 eConsults; the most frequent reasons were a positive culture or polymerase chain reaction (PCR) result, syphilis, and latent tuberculosis. Practitioners commonly requested advice on antimicrobial choice, clinical evaluation, and indications for treatment. Internal phone consultations decreased after eConsult implementation.
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Affiliation(s)
- Brian R Wood
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jessica A Bender
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sara Jackson
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Leah Rosengaus
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Paul S Pottinger
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Shireesha Dhanireddy
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Robert D Harrington
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | | | - Lisa D Chew
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - John D Scott
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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10
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Ramelson H, Nederlof A, Karmiy S, Neri P, Kiernan D, Krishnamurthy R, Allen A, Bates DW. Closing the loop with an enhanced referral management system. J Am Med Inform Assoc 2019; 25:715-721. [PMID: 29471355 DOI: 10.1093/jamia/ocy004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/07/2018] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the impact of a referral manager tool on primary care practices. Materials and Methods We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and patient communication. Results Of 1341 referrals that were initiated during the course of the study, 76.8% were completed. All the steps of the referral process were easier to accomplish following implementation of the enhanced referral manager module in the EHR. Specifically, tracking the status of an in-network referral became much easier (+1.43 [3.91-2.48] on a 5-point scale, P < .0001). Although we found improvement in the ease of performing out-of-network referrals, there was a greater impact on in-network referrals. Discussion Implementation of an electronic tool developed using user-centered design principles along with adequate staff to monitor and intervene when necessary made it easier for primary care practices to track referrals and to identify if a breakdown in the process occurred. This is especially important for high-priority referrals. Out-of-network referrals continue to present challenges, which may eventually be helped by improving interoperability among EHRs and scheduling systems. Conclusion An enhanced referral manager system can improve referral workflows, leading to enhanced efficiency and patient safety and reduced malpractice risk.
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Affiliation(s)
- Harley Ramelson
- Information Systems, Partners HealthCare, Somerville, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amanda Nederlof
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - Sam Karmiy
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - Pamela Neri
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - David Kiernan
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | | | | | - David W Bates
- Information Systems, Partners HealthCare, Somerville, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
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11
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Osman MA, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J, Zaidi D, Okpechi I, Habib S, Shojai S, Jindal K, Braam B, Keely E, Liddy C, Manns B, Tonelli M, Hemmelgarn B, Klarenbach S, Bello AK. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health 2019; 4:e001629. [PMID: 31565409 PMCID: PMC6747903 DOI: 10.1136/bmjgh-2019-001629] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Electronic consultation (eConsult)-provider-to-provider electronic asynchronous exchanges of patient health information at a distance-is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services. METHODS We applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied. RESULTS Among the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult. CONCLUSION There are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.
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Affiliation(s)
- Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Julia Kurzawa
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Syed Habib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Keely
- Departments of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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12
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Wang C, Liddy C, Afkham A, Islam S, Shehata F, Posner G, Keely E. Pathology perspective on gynaecologic malignancy screening questions in electronic consultation. J Telemed Telecare 2019; 27:123-130. [PMID: 31364473 DOI: 10.1177/1357633x19864825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The electronic consultation service, eConsult, is an asynchronous web-based platform for provider-to-provider consultation with specialists. This study described the utilization of eConsult by primary care providers to obtain specialist opinion in gynaecologic malignancy screening, with a specific focus on pathology-related inquiries. METHODS This is a cross-sectional retrospective review of eConsults submitted to obstetrics/gynaecology between September 2011 and December 2016. All questions pertaining to gynaecologic cancer screening and their pathologies were included. Each question was classified based on a pre-determined taxonomy. The mandatory primary care providers' exit surveys were analysed to determine eConsult's influence on patient care, primary care providers' referral patterns, primary care providers' satisfaction and educational value. RESULTS In total, 1,357 electronic consultations were submitted to the obstetrics and gynaecology service during the study period, of which 329 met inclusion criteria. Indications for a screening test based on patient risk factors made up 36% of consults pertaining to gynaecologic malignancy screening and 17% were inquiries about test intervals based on previous results. Primary care providers pointed out gaps in current screening guidelines. In total, 38% of primary care providers reported the eConsult service helped avoid a specialist referral, whereas 47% of primary care providers received new or additional courses of action. Pathology report interpretation accounted for 5% of eConsults and 6% of primary care providers wished for clarification of incidental pathology findings. CONCLUSION This study uncovered areas of uncertainty among primary care providers regarding gynaecologic cancer screening and gaps in current clinical guidelines. Furthermore, the role of pathology consultants in an eConsult platform is explored and may be extrapolated into practice.
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Affiliation(s)
- Carol Wang
- Department of Medicine, University of Ottawa, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Canada.,Bruyère Research Institute, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
| | - Amir Afkham
- Champlain Local Health Integration Network, Canada
| | - Shahidul Islam
- Department of Pathology and Laboratory Medicine, University of Ottawa, Canada
| | - Fady Shehata
- Department of Obstetrics and Gynecology, University of Ottawa, Canada
| | - Glen Posner
- Department of Obstetrics and Gynecology, University of Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Canada
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13
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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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14
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A pilot eConsultation service in Eastern Ontario: bridging clinical genetics and primary care. Eur J Hum Genet 2019; 27:1026-1032. [PMID: 30778171 DOI: 10.1038/s41431-019-0342-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/04/2018] [Accepted: 01/05/2019] [Indexed: 12/15/2022] Open
Abstract
With the rising demand for clinical genetics services, it is a challenge for clinical geneticists to meet the needs of patients and referring primary care providers in a timely way, using current models of genetics health care delivery. One method of providing primary care providers with greater access to clinical genetics expertise is through an electronic consultation (eConsult) service. We describe here a pilot project of a clinical genetics eConsult service that our genetics centre in Eastern Ontario, Canada provided, using the Champlain Building Access to Specialists through eConsultation (BASE)TM web-based application. We analyzed 111 genetics eConsults submitted by primary care providers to a single clinical geneticist over a 28-month time period. More than half (54%) of the eConsult questions were regarding (1) hereditary cancer and (2) genetic syndromes, with the remainder encompassing a wide variety of clinical genetics topics. We avoided a referral to the Genetics clinic for an in-person appointment for 30% of the eConsult cases, based on a contemplated referral rate to Genetics clinic of 72% prior to eConsult and a planned referral rate to Genetics clinic of 42% following all eConsults. Primary care providers rated the eConsult service of high value to themselves and also to their patients. This pilot service supports the potential of an eConsultation service to create a stronger and more dynamic link between clinical genetics and primary care providers, which may lead to better patient care.
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15
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Archibald D, Liddy C, Lochnan HA, Hendry PJ, Keely EJ. Using Clinical Questions Asked by Primary Care Providers Through eConsults to Inform Continuing Professional Development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:41-48. [PMID: 29351133 DOI: 10.1097/ceh.0000000000000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults. METHODS This study analyzes questions asked by primary care providers between July 2011 and January 2015 using a service that allows specialists to provide consultation over a secure web-based server. The content of these questions was compared with the CPD courses offered in the area in which these primary care providers are practicing over a similar period (2012-2014). The clinical questions were categorized by the content area. The percentage of questions asked about each content area was calculated for each of the 12 specialties consulted. CPD course offerings were categorized using the same list of content areas. Percentage of minutes dedicated to each content area was calculated for each specialty. The percentage of questions asked and the percentage of CPD course minutes for each content area were compared. RESULTS There were numerous congruencies and discrepancies between the proportion of questions asked about a given content area and the CPD minutes dedicated to it. DISCUSSION Traditional needs assessment may underestimate the need to address topics that are frequently the subject of eConsults. Planners should recognize eConsult questions as a valuable source of practice-associated challenges that can identify professional development needs of physicians.
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Affiliation(s)
- Douglas Archibald
- Dr. Archibald: Assistant Professor, CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Ontario, Canada. Dr. Liddy: Associate Professor, CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Ontario, Canada. Dr. Lochnan: Associate Professor, Department of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Dr. Hendry: Professor, Department of Surgery, University of Ottawa; University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Dr. Keely: Professor, Department of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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McQuillen DP, MacIntyre AT. The Value That Infectious Diseases Physicians Bring to the Healthcare System. J Infect Dis 2017; 216:S588-S593. [PMID: 28938046 PMCID: PMC7107418 DOI: 10.1093/infdis/jix326] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee-sponsored study of ID physicians' positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach-better health, better care, and lower per capita cost-that is the principle tenet of healthcare system reform.
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Affiliation(s)
- Daniel P McQuillen
- Center for Infectious Diseases and Prevention, Lahey Hospital and Medical Center, Burlington and
- Tufts University School of Medicine, Boston, Massachusetts; and
| | - Ann T MacIntyre
- Palmetto General Hospital, Hialeah, and
- Nova Southeastern University, Fort Lauderale, Florida
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