[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Patients have typically received health care through face-to-face encounters. However, expansion of electronic communication and electronic health records (EHRs) provide alternative means for patient and physicians to interact. Electronic consultations may complement regular healthcare by providing "better, faster, cheaper" processes for diagnosing, treating, and monitoring health conditions. Virtual consultation between physicians may provide a method of streamlining care, potentially saving patients the time and expense of added visits. The purpose of this study was to compare physician usage and patient satisfaction with virtual consultations (VCs) with traditional consultations (TCs) facilitated within an EHR. METHODS: We conducted an observational case-control survey study within Kaiser Permanente, Colorado. A sample of patients who had VC requests (N=270) were matched with patients who had TC requests (N=270) by patient age, gender, reason for the consult, and specialty department. These patients (VC and TC), were invited to participate in a satisfaction survey. In addition, 205 primary care physicians who submitted a VC or TC were surveyed. RESULTS: During the study period, 58,146 VC or TC were requested (TC = 96.3%). Patients who completed a satisfaction survey (268 out of 540 patients, 49.6% response rate) indicated they were satisfied with their care, irrespective of the kind of consult (mean 10-point Likert score of 8.5). 88 of 205 primary care physicians surveyed (42.9%) returned at least one survey; VC and TC survey response rates and consulted departments were comparable (p = 0.13). More TCs than VCs requested transfer of patient care (p=0.03), assistance with diagnosis (p = 0.04) or initiating treatment (p =0.04). Within 3 weeks of the consultation request, 72.1% of respondents reported receiving information from VCs, compared with 33.9% of the TCs (p < 0.001). Utility of information provided by consultants and satisfaction with consultations did not differ between VCs and TCs. CONCLUSIONS: Referring physicians received information from consultants more quickly from VCs compared with TCs, but the value and application of information from both types of consultations were similar. VCs may decrease the need for face-to-face specialty encounters without a decrease in the patient's perception of care.
BMC Medical Informatics and Decision Making 07/2012; 12(1):65. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Secure messaging within electronic medical records (EMR) between primary and specialty providers (virtual consults) may lead to streamlined care processes. Methods: An observational study of the use of traditional consults (TC) and virtual consults (VC) by adult primary care physicians to specialty departments conducted from June 2008 to November 2008. We compiled data for all consult orders made within the EMR. We conducted manual chart reviews, physician and patient surveys on a random selection of consults to determine the reason for the consult, the advice returned, the number of people involved in processing the consult, and the turn -around time for the consult. We report mid-study descriptive statistics on the number of patients with consults, patient demographics, the types of consults, and to which departments. We also report on the number of patient satisfaction surveys attempted and completed. Results: We identified 33,390 consult orders (93.6% TC, 6.4% VC) for 27,932 patients with ages ranging from 18 to 99 (mean 53.95). Of these patients, 83.8% had one, 13.5% had two, and 2.7% had three or more consult orders. The top departments for TC were: Physical Therapy (29.2%), Orthopedics (11.9%), Cardiology (11.2%), General Surgery (8.8%), and Dermatology (8.3%). The top departments for VC were: Dermatology (18.3%), Neurosurgery (12.3%), Endocrinology (9.6%), Neurology (7.2%), and General Surgery (6.2%). The average response time for VC was 3.2 days (range 130 days) with over 50% returned within one day. We randomly selected 540 patients (equally divided between TC and VC), contacted 340 thus far, and 154 participated in the survey. Forty percent of these patients received VC and 67% of these patients eventually saw a specialist. Of all patients surveyed, 79.4% were satisfied with the specialist recommendations (not significantly different between consult types). Conclusions: The primary care providers use virtual consults for different purposes than traditional consults. Physician and patient surveys and chart reviews are scheduled for completion in 2009 allowing a full comparison of virtual consults to traditional consults from multiple perspectives. If effective, virtual consults may improve patient satisfaction and streamline the care delivery process.
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Shared Electronic Medical Record (EMR) systems could increase communication between primary and specialty care. Electronic (virtual) EMR consults (VC) could streamline patient care. We describe physician use of VCs within Kaiser Permanente's HealthConnect EMR, compared with traditional requests for consults (TC). Methods: Prospective, observational, case control study comparing VCs with TCs from Kaiser Colorado adult primary care physicians to several specialty departments. Every 2 weeks from June to November 2008, VCs were randomly selected and matched with TCs by requesting physician specialty, reason for referral, referral department, patient gender and age. Referring physicians were asked to complete an online survey on reason for consult, answers received, if answers met immediate patient care needs, likelihood of using (or actual use of) the information in subsequent patient care, the impact of the consult process on physician work flow, and their overall satisfaction with the consult. Results: Eighty-two of 205 unique physicians responded on 62 VCs and 49 TCs; overall return rate was 26.4% (30.0% of 207 VCs and 22.9% of 214 TCs). Etiology, screening and evaluation questions were similarly common reasons for both types of consults; requests to initiate treatment or assume care were more common in TCs. Seventy-four percent of physicians requesting VCs and 39% of those requesting TCs received information from the consultant by the time of survey completion; 91% of these physicians used at least some information from the referral in caring for the index patient. Fifteen percent had already used the information in the care of subsequent patients; 41% thought they would likely use the information in the future; 29% thought they would not likely use the information in the future. Sixty percent of physicians who received information were satisfied with the information from the referral, 24% were dissatisfied, with no difference between VCs and TCs. Conclusions: Referring physicians received information more quickly from VCs than TCs. Consult reasons, use of information received in the index and subsequent patients, and overall satisfaction with information were similar between VCs and TCs. Additional analysis will explore longer term educational outcomes, patient satisfaction, and economic differences between VCs and TCs.