Comparing virtual consults to traditional consults using an electronic health record: an observational case–control study

BMC Medical Informatics and Decision Making

Research Article

David Price¹  Ted E Palen²  Susan Shetterly³  Kristin B Wallace⁴ 

[1] Department of Education, Colorado Permanente Medical Group, Institute for Health Research, Department of Family Medicine, University of Colorado Denver Health Sciences Center, Denver, CO, USA;Department of Internal Medicine, Colorado Permanente Medical Group, Institute for Health Research, Kaiser Permanente, Denver, CO, USA;Institute for Health Research, Kaiser Health Plan Colorado, Denver, CO, USA;Knowledge Management and Implementation, Support, Kaiser Health Plan Colorado, Denver, CO, USA;

关键词: Consultations;    Referrals;    Electronic medical record;    Value of information;    Physician satisfaction;    Patient satisfaction;   

DOI  :  10.1186/1472-6947-12-65

 received in 2011-11-16, accepted in 2012-06-25,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPatients 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.MethodsWe conducted an observational case–control survey study within Kaiser Permanente, Colorado. A sample of patients who had VCs requested by physicians (N = 270) were matched with patients who had TCs requested by physicians (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.ResultsDuring the study period, 58,146 VC or TC were requested (TC = 96.3%). Patients who completed a satisfaction survey (267 out of 540 patients, 49.4% 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.ConclusionsReferring 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.

【 授权许可】

CC BY   
© Palen et al.; licensee BioMed Central Ltd. 2012