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Open Access Highly Accessed Research article

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

Ted E Palen1*, David Price2, Susan Shetterly3 and Kristin B Wallace4

Author Affiliations

1 Department of Internal Medicine, Colorado Permanente Medical Group, Institute for Health Research, Kaiser Permanente, Denver, CO, USA

2 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

3 Institute for Health Research, Kaiser Health Plan Colorado, Denver, CO, USA

4 Knowledge Management and Implementation, Support, Kaiser Health Plan Colorado, Denver, CO, USA

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BMC Medical Informatics and Decision Making 2012, 12:65  doi:10.1186/1472-6947-12-65

Published: 8 July 2012

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 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.

Results

During 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.

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.

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