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Yu H, Chiu YL, Wang JN, Yu J, Hsu YT. Electronic consultation accessibility influence on patient assessments: A case-control study with user-generated tags of physician expertise. Digit Health 2023; 9:20552076231180693. [PMID: 37334321 PMCID: PMC10272648 DOI: 10.1177/20552076231180693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Objective In online health communities (OHCs), patients often list their physicians' expertise by user-generated tags based on their consulted diseases. These expertise tags play an essential role in recommending the match of physicians to future patients. However, few studies have examined the impact of the accessibility of e-consults on patient assessments using marking of the physicians' expertise in OHCs. This study aims to investigate what are the patient assessments of the physicians' expertise if they have e-consult accessibility. Methods Through a case-control study, this article examined the effect of e-consult accessibility on patient-generated tags of physician expertise in OHCs. With data collected from the Good Doctor website, the samples consisted of 9841 physicians from 1255 different hospitals widely distributed in China. The breadth of voted expertise (BE) is measured by the number of consulted disease-related labels marked by a physician's served patients (SP). The volume of votes (VV) is measured by the number of a physician's votes given by the SP. The degree of voted diversity (DD) is measured by the information entropy of each physician's service expertise (labeled and voted by patients). The data analysis of e-consult accessibility is conducted by estimating the average treatment effect on the DD of physicians' expertise. Results For the BE, its mean was 7.305 for the case group of physicians with e-consults accessible (photo and text queries), while the mean was 9.465 for the control for physicians without e-consults. For the VV, its mean was 39.720 for the case group, while the mean was 84.565 for the control. For the DD, its mean on patient-generated tags was 2.103 for the case group, which is 0.413 lower than the control group. Conclusion The availability of e-consults increases the concentration on physician expertise in the patient-generated tags. e-Consults reinforce the increment of the already-received physician expertise (reflected in tags), reducing the tag information diversity.
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Affiliation(s)
- Haiyan Yu
- Center for Data and Decision Sciences, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Ya-Ling Chiu
- College of International Business, Zhejiang Yuexiu University, Zhejiang, China
| | - Jying-Nan Wang
- College of International Business, Zhejiang Yuexiu University, Zhejiang, China
| | - Jiang Yu
- The Fourth People's Hospital of Banan District, Chongqing, China
| | - Yuan-Teng Hsu
- Research Center of Finance, Shanghai Business School, Shanghai, China
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Abstract
PURPOSE OF REVIEW Although telemedicine and telehealth services have been a part of type 1 diabetes (T1D) clinical care for several decades, the expansion of in-home telemedicine during the COVID-19 pandemic significantly increased interest in long-term use as part of routine care. This review highlights the current literature regarding telemedicine in T1D care as well as the benefits and barriers to use in a postpandemic world. RECENT FINDINGS Telemedicine has increased patient contact with healthcare providers, allowing for more frequent insulin dose adjustments and improvements in glycemic outcomes. In addition to routine clinical care, T1D device training and mental healthcare have been successful through telemedicine. Significant barriers to continued telemedicine care exist, including patient access and technology knowledge, language, and loss of face-to-face interaction. Healthcare providers additionally face unpredictable reimbursement and loss of continuity across state lines, and lack of resources and training for device downloads and telemedicine software. SUMMARY Telemedicine can be successfully used in T1D care and has the potential to significantly impact glycemic and long-term outcomes. Due to continued interest for in-person visits by people with T1D and providers, it is likely that long-term telemedicine use will include a hybrid format.
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Affiliation(s)
- Erin C Cobry
- Barbara Davis Center for Diabetes Institution, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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[E-consultation as a tool for the relationship between Primary Care and Endocrinology. Impact of COVID-19 epidemic in its use]. J Healthc Qual Res 2022; 37:155-161. [PMID: 34866028 PMCID: PMC9847372 DOI: 10.1016/j.jhqr.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Electronic consultation (eConsultation) can precede, complete, or replace visits to the specialist. OBJECTIVE To describe the profile of eConsultations issued from Primary Care (PC) to the Endocrinology Unit since their implementation in our hospital, to assess the response time and to evaluate changes in trends in relation to the COVID19 pandemic. A secondary objective is to evaluate the degree of satisfaction of PC specialists with this tool. MATERIAL AND METHODS An observational retrospective study of Endocrinology eConsultations conducted from June 2019 to October 2020 analysing 2periods: pre-COVID and post-COVID. The degree of satisfaction of the Family and Community Medicine specialists was assessed by means of a questionnaire. RESULTS 391 eConsultations were answered (69 pre-COVID and 322 post-COVID). The response time was less than 24h in 85% of them. A total of 35.3% were resolved without the need for visits or additional tests. Thyroid pathology was the most consulted. The incidence was significantly higher in the post-COVID period. The proportion of high resolution was significantly higher in the pre-COVID period. There were no differences in the rest of the parameters analysed in both periods. Thirty-nine point 2percent of PC specialists answered the survey. The degree of satisfaction of PC specialists was high. A total of 92.7% considered that the tool met their expectations and 90.5% were satisfied or very satisfied with its use. CONCLUSION The COVID epidemic has driven the use of eConsultation in Endocrinology, which makes it possible to precede, complete or replace visits to the specialist, with a high degree of user satisfaction.
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Thomas A, Thomas A. Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life? J Patient Exp 2021; 7:989-993. [PMID: 33457535 PMCID: PMC7786766 DOI: 10.1177/2374373520967798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.
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Affiliation(s)
- Andrew Thomas
- Bharati Vidyapeeth Medical College, Pune, India.,Research Volunteer, All of US Research Program, University of Illinois Health Sciences System, Chicago, IL, USA
| | - Annie Thomas
- Marcella Niehoff School of Nursing, Loyola University Chicago, BVM Hall, Chicago, IL, USA
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5
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Castaneda PR, Duffy B, Andraska EA, Stevens J, Reschke K, Osborne N, Henke PK. Outcomes and safety of electronic consult use in vascular surgery. J Vasc Surg 2019; 71:1726-1732. [PMID: 31611112 DOI: 10.1016/j.jvs.2019.08.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to determine how electronic consults (eConsults) are used in vascular surgery in a veterans health care setting and whether their use is safe for patients. METHODS A retrospective review was performed of all eConsults completed by the vascular surgery service at the Ann Arbor Veterans Affairs Healthcare System between October 10, 2012 and November 15, 2013. Patients' demographics and comorbidities were collected. eConsult recommendations and patient and provider compliance with recommendations were collected. Data on adverse outcomes up to 1 year after consultation and data on all-cause mortality at 1 year and 5 years were collected. RESULTS Between October 10, 2012 and November 15, 2013, of 350 eConsults completed, 123 (35%) were for peripheral artery disease, 93 (27%) for carotid stenosis, and 57 (16%) for abdominal aortic aneurysm. Unique recommendations were made for 291 consults (83%). Medication recommendations were made in 140 consults (40%). The most commonly recommended medication was cilostazol. Compliance with medication recommendations ranged from 30% to 61%. Noninvasive imaging was recommended in 220 consults (60.3%). Procedures overall were recommended in only six consults (1.7%). Five-year all-cause mortality for categorized diagnoses ranged from 8.3% for nonabdominal aneurysm to 28.1% for abdominal aortic aneurysm. CONCLUSIONS Within the Veterans Affairs vascular surgery service, eConsults provide a safe and effective means of triaging and providing recommendations for patients with vascular disease. eConsults used to augment traditional consultations may provide an important means of reducing clinic congestion for providers and reducing time and cost for patients.
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Affiliation(s)
| | - Blake Duffy
- University of Michigan Medical School, Ann Arbor, Mich
| | - Elizabeth A Andraska
- Heart and Vascular Institute, University of Pittsburgh Medical Centers, Pittsburgh, Pa
| | | | | | - Nicholas Osborne
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
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Venkatesh RD, Campbell EJ, Thiim M, Rao SK, Ferris TG, Wasfy JH, Richter JM. e-Consults in gastroenterology: An opportunity for innovative care. J Telemed Telecare 2018; 25:499-505. [DOI: 10.1177/1357633x18781189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and aim Deploy and evaluate a gastroenterology (GI) electronic consultation (e-consult) program. E-consults are a promising approach to enhance provider communication, facilitate timely specialty advice and may replace some outpatient visits. Study As part of our health system’s efforts to provide more cost-effective care under risk-based contracts, we implemented an e-consult program where referring providers submit patient-specific clinical questions electronically via an electronic referral system. A GI consultant then reviews the patient’s record and provides a written recommendation back to the referring physician. For our program evaluation, we conducted chart reviews of each e-consult to understand how the program was being used and surveyed the participating providers and consultants. Results From September 2015 to March 2016, we received 144 e-consults, with most questions concerning GI symptoms or abnormal hepatology labs. Only 36% of e-consults recommended an in-person GI consult or procedure. In our survey of participating providers, referring providers strongly agreed that the GI e-consults promoted good patient care (88%) and were satisfied with the program (84%). The majority of GI consultants felt strongly that e-consults were useful for referring providers and their patients, but that current reimbursement and time allotted were not adequate. Conclusions We report on the implementation of a GI e-consult program within an ACO, showing that many clinical questions could be answered using this mechanism. E-consults in gastroenterology have the potential to reduce unnecessary visits and/or procedures for patients who can be managed by their primary provider, potentially increasing access for other patients.
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Affiliation(s)
- Rajitha D Venkatesh
- Duke Pediatric GI & Nutrition, Duke University Medical Center, Durham, NC, USA
| | - Emily J Campbell
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Thiim
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sandhya K Rao
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Timothy G Ferris
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jason H Wasfy
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Kim EJ, Orlander JD, Afable M, Pawar S, Cutrona SL, Simon SR, Strymish J, Vimalananda VG. Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England. J Telemed Telecare 2018; 25:370-377. [PMID: 29754562 DOI: 10.1177/1357633x18774468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. METHODS This is a retrospective analysis of 750 patients' medical charts with cardiology e-consults requested by medical providers (October 2013-September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists' responses and examined their recommendations. RESULTS Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment (n = 44), anti-coagulation/anti-platelet management (n = 33), and EKG interpretation (n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance (n = 41), the reasons included missing or insufficient clinical information (n = 18), medical complexity (n = 6), and deferment to the patient's non-VA primary cardiologist (n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. DISCUSSION Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.
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Affiliation(s)
- Eun Ji Kim
- 1 Division of General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, USA
| | - Jay D Orlander
- 2 Medical Service, VA Boston Healthcare System, USA.,3 Evans Department of Medicine, Boston University School of Medicine, USA
| | - Melissa Afable
- 4 Center for Healthcare Organization and Implementation Research, Partners Healthcare, USA
| | - Sumeet Pawar
- 5 Department of Cardiology, Yale School of Medicine, USA
| | - Sarah L Cutrona
- 6 Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical Center, USA.,7 Department of Quantitative Health Science, University of Massachusetts Medical School, USA
| | - Steven R Simon
- 8 Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, MA, USA.,9 Harvard Medical School, USA
| | - Judith Strymish
- 2 Medical Service, VA Boston Healthcare System, USA.,9 Harvard Medical School, USA
| | - Varsha G Vimalananda
- 3 Evans Department of Medicine, Boston University School of Medicine, USA.,6 Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical Center, USA
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Aller MB, Vargas I, Coderch J, Vázquez ML. Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system. BMC Health Serv Res 2017; 17:842. [PMID: 29273045 PMCID: PMC5741878 DOI: 10.1186/s12913-017-2690-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical coordination is considered a health policy priority as its absence can lead to poor quality of care and inefficiency. A key challenge is to identify which strategies should be implemented to improve coordination. The aim is to analyse doctors' opinions on the contribution of mechanisms to improving clinical coordination between primary and outpatient secondary care and the factors influencing their use. METHODS A qualitative descriptive study in three healthcare networks of the Catalan national health system. A two-stage theoretical sample was designed: in the first stage, networks with different management models were selected; in the second, primary care (n = 26) and secondary care (n = 24) doctors. Data were collected using semi-structured interviews. Final sample size was reached by saturation. A thematic content analysis was conducted, segmented by network and care level. RESULTS With few differences across networks, doctors identified similar mechanisms contributing to clinical coordination: 1) shared EMR facilitating clinical information transfer and uptake; 2) mechanisms enabling problem-solving communication and agreement on clinical approaches, which varied across networks (joint clinical case conferences, which also promote mutual knowledge and training of primary care doctors; virtual consultations through EMR and email); and 3) referral protocols and use of the telephone facilitating access to secondary care after referrals. Doctors identified organizational (insufficient time, incompatible timetables, design of mechanisms) and professional factors (knowing each other, attitude towards collaboration, concerns over misdiagnosis) that influence the use of mechanisms. DISCUSSION Mechanisms that most contribute to clinical coordination are feedback mechanisms, that is those based on mutual adjustment, that allow doctors to exchange information and communicate. Their use might be enhanced by focusing on adequate working conditions, mechanism design and creating conditions that promote mutual knowledge and positive attitudes towards collaboration.
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Affiliation(s)
- Marta-Beatriz Aller
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut; Serveis de Salut Integrats Baix Empordà, Hospital, 17-19 Edif. Fleming, 17230 Palamós, Spain
| | - Maria-Luisa Vázquez
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
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Parikh PJ, Mowrey C, Gallimore J, Harrell S, Burke B. Evaluating e-consultation implementations based on use and time-line across various specialties. Int J Med Inform 2017; 108:42-48. [PMID: 29132630 DOI: 10.1016/j.ijmedinf.2017.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Electronic Consultation (e-consults) can provide improved access, enhance patient and provider satisfaction, and reduce beneficiary travel expenses. We explored how e-consults were implemented across three specialty areas, diabetes (Diab), gastroenterology (GI), and neurosurgery (Neuro), at two Veterans Affairs hospitals in terms of strategies for use and time-lines. METHODS We conducted observations and electronically shadowed patient e-consultations submitted to a specialty care service by primary care provider(s) at the two sites during a thirteen-month period. We divided the e-consult process in each specialty into three broad milestones; Request (from primary to specialty), Response (from specialty back to primary), and Follow up (from primary to patient), and recorded the flow and time in each category. An overall hierarchy of e-consults was developed to illustrate the many ways an e-consult was used. The Kolmogorov-Smirnov test was used to compare the distribution of time across specialties. RESULTS A total of 394 consults submitted between April 14, 2012 and May 2, 2013 were reviewed (Diab=152, GI=169, Neuro=73). Of the 152 diabetes specialty clinic e-consults, 35% required some sort of direct contact with the patient by the specialty clinic before a recommendation was provided. Overall, 58% of the e-consults were completed within 20days, while 68% were completed within 30days. The Response times between Diab and GI were significantly different (median=0 vs. 3days; p<0.0001) and so were Follow up times (median=0 vs. 4days; p<0.0001). All three stages were statistically different between Diab and Neuro; however, there was not enough evidence to suggest any differences between GI and Neuro. CONCLUSIONS The use of an e-consult is likely to vary based on the specialty, but the often significant variations in time may continue to hinder prompt access to care. E-consult design, implementation, documentation, training, self-learning, and monitoring should be tailored to get the most benefit out of this system.
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Affiliation(s)
- Pratik J Parikh
- Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States; Dept of Surgery, Wright State University, Dayton, OH, United States.
| | - Corinne Mowrey
- Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States.
| | - Jennie Gallimore
- Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States; Dept of Surgery, Wright State University, Dayton, OH, United States.
| | - Stephen Harrell
- Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States.
| | - Brian Burke
- Dayton Veterans Affairs Medical Center, Dayton, OH, United States; Dept of Internal Medicine, Wright State University, Dayton, OH, United States.
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Wasfy JH, Rao SK, Essien UR, Richardson CA, Jeune T, Goldstein SA, Laikhter E, Chittle MD, Weil M, Wein M, Ferris TG. Initial experience with endocrinology e-consults. Endocrine 2017; 55:640-642. [PMID: 27507674 DOI: 10.1007/s12020-016-1053-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sandhya K Rao
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Utibe R Essien
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Tamika Jeune
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan A Goldstein
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Laikhter
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa D Chittle
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Weil
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc Wein
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy G Ferris
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Pecina JL, Frank JM, North F. A retrospective study on how primary care providers manage specialists' recommendations after an e-consultation. SAGE Open Med 2016; 4:2050312116682127. [PMID: 28348734 PMCID: PMC5354179 DOI: 10.1177/2050312116682127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction: E-consultations are asynchronous text-based consultations between providers which can facilitate patient access to timely specialty care. In contrast to traditional face-to-face consults, conveying and completing recommendations of the specialist is the responsibility of the referring provider. This presents a new workflow for primary care providers who have multiple options (face-to-face, telephone, letter, secure message) to communicate the e-consultation recommendations. This study examines how primary care providers are managing this new workflow. Methods: We performed a retrospective random sampling of e-consultations with individual medical record review and classified e-consultations by type of recommendation, how recommendations were communicated to patients, and whether recommendations were carried out. Results: We randomly selected 220 e-consultations in 13 different specialties for review. In all, 85% of e-consultations contained recommendations for referring providers. Recommendations on medication(s) were most common (35%) followed by recommendations on ordering laboratory tests (29%). In all, 25% of the time e-consultants gave multiple possible courses of action for referring providers to choose from. Patient notification of recommendations was found for 192 (87%) of e-consultations with providers performing the notification 63% of the time and nursing staff performing the notification 37% of the time. The communication back to the patients included communication via nurse telephone calls (37%), provider telephone calls (23%), secure messages (24%), face-to-face visits (11%), and by written correspondence (5%). Discussion: Managing recommendations from e-consultations results in a new workflow for primary care providers. Healthcare institutions that utilize e-consults should be aware of this new workflow. Further study is needed to determine best practices for this task that is now increasing in primary care.
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Affiliation(s)
| | | | - Frederick North
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Vimalananda VG, Gupte G, Seraj SM, Orlander J, Berlowitz D, Fincke BG, Simon SR. Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis. J Telemed Telecare 2015; 21:323-30. [PMID: 25995331 PMCID: PMC4561452 DOI: 10.1177/1357633x15582108] [Citation(s) in RCA: 269] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/22/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND We define electronic consultations ("e-consults") as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults. METHODS We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based. RESULTS Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers. DISCUSSION E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gouri Gupte
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Siamak M Seraj
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jay Orlander
- VA Boston Healthcare System, Boston, Massachusetts, USA Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dan Berlowitz
- Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Benjamin G Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA VA Boston Healthcare System, Boston, Massachusetts, USA Division of General Internal Medicine, Brigham and Women's Hospital, Boston Massachusetts, USA Harvard Medical School, Massachusetts, USA
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Yu DJ, Ebaid A. To Consult or Not to Consult: The Role of the Endocrinologist in the Management of Diabetes Mellitus in the Hospital Setting. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40138-015-0065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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