1
|
Høpfner Jensen LW, Kold S, Dinesen B, Husum HC, Skals RG, Eiskjær SP, Elsøe R, Rahbek O. Team-based digital communication reduced patient-initiated phone calls to the hospital and improved patient satisfaction after orthopedic surgery: a randomized controlled trial in 70 patients. Acta Orthop 2024; 95:225-232. [PMID: 38757681 PMCID: PMC11100491 DOI: 10.2340/17453674.2024.40707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND PURPOSE Post-discharge inquiries to the hospital are predominantly conducted through phone calls. The rigid timing of these calls is inconvenient for patients and disrupts the workflows of healthcare professionals. The aim of this study was to investigate the effect of a team-based digital communication intervention (eDialogue) facilitated through a messenger-like commercial solution on patient-initiated phone calls to the hospital after discharge. Secondarily, we investigated other patient-initiated contacts, patients' perception of continuity of care, and their perception of feeling safe and satisfied after hospital discharge. METHODS On the day of discharge, 70 surgically treated orthopedic patients were randomized to the intervention group with access to eDialogue (n = 35) or the control group with standard communication pathways by phone call (n = 35) for the following 8 weeks. Through eDialogue, the intervention group had access to team-based asynchronous digital communication in text and photos with healthcare professionals across disciplines and sectors. Inclusion criteria were discharge to own home and receipt of rehabilitation services from both hospital and primary care after discharge. RESULTS We found a significant reduction in the mean number of patient-initiated phone calls to the hospital from 2.3 (95% confidence interval [CI] 1.4-4.1) in the control group to 0.5 (CI 0.3-1.0) in the intervention group (P = 0.004). Across groups, patients reported similar perceptions of continuity of care; however, the participants in the intervention group expressed significantly improved perceptions of, and satisfaction with, access to healthcare after discharge. CONCLUSION Access to eDialogue reduced patient-initiated phone calls to the hospital, enhanced patient satisfaction with healthcare accessibility, and did not compromise patients' perception of continuity of care after discharge compared with standard communication pathways.
Collapse
Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg; Laboratory for Welfare Technologies - Digital Health & Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg East.
| | - Søren Kold
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg East
| | - Hans-Christen Husum
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | | | - Søren Peter Eiskjær
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Rasmus Elsøe
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| |
Collapse
|
2
|
Yakushi J, Wintner M, Yau N, Borgo L, Solorzano E. Utilization of Secure Messaging to Primary Care Departments. Perm J 2020; 24:19.177. [PMID: 33196426 DOI: 10.7812/tpp/19.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Secure messaging is a platform for email communication between patients and their physicians. Although patient-generated emails are associated with increased use of clinical services, greater member retention, and improved quality of care, secure messaging has a marked impact on primary care physicians' workload. OBJECTIVE To understand how the email topic and volume vary by demographics and clinical factors among members of a managed care organization. METHODS We analyzed all secure messages sent to primary care departments by adult members of Kaiser Permanente Southern California (KPSC) in 2017. RESULTS Members with a higher volume of office visits and telephone appointment visits generated a higher volume of emails to primary care physician. Members with a Centers of Medicare and Medicaid Services Hierarchical Condition Category diagnosis history sent 3 times as many emails as those without such a diagnosis history. Women accounted for nearly two-thirds of emails despite making up only half of the KPSC member population. Less than one-fourth (21.4%) of members sent 2.3 million total emails to their physician. Medical advice was the most common reason for sending secure messages (24.7%) in a sample studied (n = 2397). DISCUSSION These findings confirm the need for additional research to more accurately quantify the additional burden from secure message utilization on primary care physicians. Knowing the factors associated with secure messaging usage and message content could assist in building more efficient staffing models and creating more efficient routing that matches the message content with a physician's scope of practice.
Collapse
Affiliation(s)
- Jose Yakushi
- Department of Family Medicine, Downey Medical Center, CA
| | - Mose Wintner
- Department of Health Innovation, Southern California Permanente Medical Group, Tustin, CA
| | - Naomi Yau
- Department of Health Innovation, Southern California Permanente Medical Group, Tustin, CA
| | - Lina Borgo
- Department of Health Innovation, Southern California Permanente Medical Group, Tustin, CA
| | | |
Collapse
|
3
|
Tan H, Yan M. Physician-user interaction and users' perceived service quality: evidence from Chinese mobile healthcare consultation. INFORMATION TECHNOLOGY & PEOPLE 2020. [DOI: 10.1108/itp-01-2019-0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PurposeThe significance of physician-user interaction has been widely acknowledged in offline and online healthcare consultation. However, limited attempts have been made to explore the influence of physician-user interaction on users' perceived service quality (PSQ) in the mobile context. Based on the literature on physician-user interaction and media synchronicity theory, this study proposes a theoretical model where the interactive factors common across the offline, online and mobile context, i.e. physicians' informational support and emotional support, the interactive factors unique in the mobile context, i.e. physicians' response speed and voice service, and the interaction between the two categories of interactive factors predict users' PSQ in mobile consultation.Design/methodology/approachThis study collects consultation records between 25,225 users and 738 physicians from a leading Chinese mobile consultation application, and employs linear regression to verify the proposed theoretical model.FindingsPhysicians' informational, emotional support, response speed and voice service are found to have significant positive impacts on users' PSQ. Besides, physicians' response speed strengthens the positive impacts of physicians' informational and emotional support on users' PSQ, while physicians' voice service weakens the positive link between physicians' informational support on users' PSQ.Originality/valueThis study contributes to the antecedents for users' PSQ in mobile consultation by identifying unique interactive factors in the mobile context, and highlighting the individual and interaction effects of different physician-user interactive factors. Besides, this study employs novel methods, which leverages text classification and text pattern recognition to more accurately depict physicians' online behaviors based on objective communication records.
Collapse
|
4
|
Zanaboni P, Fagerlund AJ. Patients' use and experiences with e-consultation and other digital health services with their general practitioner in Norway: results from an online survey. BMJ Open 2020; 10:e034773. [PMID: 32554721 PMCID: PMC7304835 DOI: 10.1136/bmjopen-2019-034773] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To explore patients' use and experiences with four digital health services implemented in Norway to enable electronic communication between patients and their general practitioner (GP): (1) electronic booking of appointments; (2) electronic prescription renewal; (3) electronic contact with the GP's office for non-clinical inquiries; and (4) e-consultation for clinical inquiries. DESIGN An online survey consisting of quantitative data supplemented by qualitative information was conducted to explore: (1) characteristics of the users; (2) use; (3) experiences, perceived benefits and satisfaction; and (4) time spent using the digital health services. SETTING Primary care. PARTICIPANTS 2043 users of the digital health services answering the survey. RESULTS There was a higher proportion of women, younger adults and digitally active citizens with high education. Electronic booking of appointments was the most used service (66.4%), followed by electronic prescription renewal (54.3%). Most users (80%) could more easily and efficiently book an appointment electronically than by phone. Over 90% of the respondents thought that it was easier to renew a prescription electronically, 76% obtained a better overview of their medications and 46% reported higher compliance. For non-clinical inquiries, most respondents (60%) thought that it was easier to write electronic messages than communicate by phone. For clinical enquiries, many patients agreed that e-consultation could lead to a better followup (72%) and improved quality of treatment (58%). Users were highly satisfied with the services and recommended their use to others. Time saving was the most evident benefit for patients. This was confirmed by the differences in time spent using the digital health services compared with conventional approaches, all found to be statistically significant. CONCLUSION Citizens using e-consultation and other digital health services with their GP in Norway are satisfied and consider them as useful and efficient alternatives to conventional approaches.
Collapse
Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Troms, Norway
| | | |
Collapse
|
5
|
Salisbury C, Murphy M, Duncan P. The Impact of Digital-First Consultations on Workload in General Practice: Modeling Study. J Med Internet Res 2020; 22:e18203. [PMID: 32543441 PMCID: PMC7327596 DOI: 10.2196/18203] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially increase doctors’ workload. Objective The aim of this study was to explore whether and under what circumstances digital-first access to general practice is likely to decrease or increase general practice workload. Methods A process map to delineate primary care access pathways was developed and a model to estimate general practice workload constructed in Microsoft Excel (Microsoft Corp). The model was populated using estimates of key variables obtained from a systematic review of published studies. A MEDLINE search was conducted for studies published in English between January 1, 2000, and September 30, 2019. Included papers provided quantitative data about online, telephone, or video consultations for unselected patients requesting a general practice in-hours consultation for any problem. We excluded studies of general practitioners consulting specialists, consultations not conducted by doctors, and consultations conducted after hours, in secondary care, in specialist services, or for a specific health care problem. Data about the following variables were extracted from the included papers to form the model inputs: the proportion of consultations managed digitally, the proportion of digital consultations completed without a subsequent consultation, the proportion of subsequent consultations conducted by telephone rather than face-to-face, consultation duration, and the proportion of digital consultations that represent new demand. The outcome was general practice workload. The model was used to test the likely impact of different digital-first scenarios, based on the best available evidence and the plausible range of estimates from the published studies. The model allows others to test the impact on workload of varying assumptions about model inputs. Results Digital-first approaches are likely to increase general practice workload unless they are shorter, and a higher proportion of patients are managed without a subsequent consultation than observed in most published studies. In our base-case scenarios (based on the best available evidence), digital-first access models using online, telephone, or video consultations are likely to increase general practitioner workload by 25%, 3%, and 31%, respectively. An important determinant of workload is whether the availability of digital-first approaches changes the demand for general practice consultations, but there is little robust evidence to answer this question. Conclusions Digital-first approaches to primary care could increase general practice workload unless stringent conditions are met. Justification for these approaches should be based on evidence about the benefits in relation to the costs, rather than assumptions about reductions in workload. Given the potential increase in workload, which in due course could worsen problems of access, these initiatives should be implemented in a staged way alongside careful evaluation.
Collapse
Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mairead Murphy
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Polly Duncan
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
6
|
Yan M, Tan H, Jia L, Akram U. The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2579. [PMID: 32283741 PMCID: PMC7178203 DOI: 10.3390/ijerph17072579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients' perspective, this work focuses on the mobile context and take both doctors' and mobile consultation users' perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors' and patients' information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context.
Collapse
Affiliation(s)
- Mengling Yan
- School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing 100876, China; (M.Y.); (L.J.)
| | - Hongying Tan
- School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing 100876, China; (M.Y.); (L.J.)
| | - Luxue Jia
- School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing 100876, China; (M.Y.); (L.J.)
| | - Umair Akram
- Guanghua School of Management, Peking University, Beijing 100871, China;
| |
Collapse
|
7
|
Katz DA, Hamlin C, Vander Weg MW, Grant KM, Stewart Steffensmeier KR, Paez M, Hawley ST, Gaeth G. Veterans' preferences for tobacco treatment in primary care: A discrete choice experiment. PATIENT EDUCATION AND COUNSELING 2020; 103:652-660. [PMID: 31629558 DOI: 10.1016/j.pec.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate US veterans' preferences for smoking cessation counseling and pharmacotherapy. METHODS A discrete choice experiment (DCE) was conducted in 123 Veterans Health Administration primary care outpatients who planned to quit smoking within 6 months. Key attributes of tobacco cessation treatment were based on literature review and expert opinion. We used a hierarchical Bayesian approach with a logit model to estimate the part-worth utility of each attribute level and used latent class logit models to explore preference heterogeneity. RESULTS In the aggregate, participants valued counseling options with the following attributes: higher quit rate at 1 year, emphasis on autonomy, familiarity of the counselor, counselor's communication skills, and inclusion of printed materials on smoking cessation. Participants valued pharmacotherapy options with the following attributes: higher quit rate at 1 year, lower risk of physical side effects, zero copayment, monthly check-in calls, and less weight gain. Latent class analysis revealed distinct clusters of patients with a unique preference "phenotype." CONCLUSIONS Veterans have distinct preferences for attributes of cessation counseling and pharmacotherapy. PRACTICE IMPLICATIONS Identifying patients' preferences provides an opportunity for clinicians to offer tailored treatment options that better engage veterans in their own care and boost adherence to guideline-recommended counseling and pharmacotherapy.
Collapse
Affiliation(s)
- David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Christine Hamlin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System and the Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kenda R Stewart Steffensmeier
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Monica Paez
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Sarah T Hawley
- Ann Arbor Veterans Administration (VA) Healthcare System, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Gary Gaeth
- Tippie School of Business, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
8
|
Rodgers M, Raine G, Thomas S, Harden M, Eastwood A. Informing NHS policy in ‘digital-first primary care’: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies.
Objectives
This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage.
Data sources
Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied.
Review methods
After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer.
Results
Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified.
Limitations
The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review.
Conclusions
Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking.
Funding
The National Institute for Health Research Health Service and Delivery Research programme.
Collapse
Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gary Raine
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
9
|
Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e078. [PMID: 30680368 PMCID: PMC6336578 DOI: 10.5435/jaaosglobal-d-18-00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Outpatient surgery has a great opportunity to demonstrate the role of using mobile video conference (VC) postoperatively. Our patients use technology to help decision making in finding physicians. The authors aim to assess patient's perception on the use of mobile apps for VC with the surgeon and/or staff. Methods: Consenting patients completed a questionnaire of 10 questions preoperatively and postoperatively to assess the difference in opinion. Results: Overall, 120 patients completed the questionnaire preoperatively with 58% female population, 71% younger than 65 years, and 67% having a GED/higher education. Fifty-two patients had surgery with 54% female population, and 60% were younger than 65 years. All patients had mobile apps for VC with 55% using WhatsApp, 40% using Facetime, and 5% other. In person, being with a trained educator at the office was the preferred method for learning about surgical procedures. Overall, four patients contacted the surgeon directly preoperatively. After surgery, 8 of 52 patients (15%) used VC to the surgeon directly, and 37 patients used the VC with the team. Conclusion: With advances in new technology, the use of mobile video conferencing adds a new forum for communication with patients. In the outpatient surgical setting, this forum would improve patient-physician relations.
Collapse
|
10
|
Bavafa H, Hitt LM, Terwiesch C. The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care. MANAGEMENT SCIENCE 2018; 64:5461-5480. [PMID: 33033417 PMCID: PMC7540911 DOI: 10.1287/mnsc.2017.2900] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Secure messaging, or "e-visits," between patients and providers has sharply increased in recent years, and many hope they will help improve healthcare quality, while increasing provider capacity. Using a panel data set from a large healthcare system in the United States, we find that e-visits trigger about 6% more office visits, with mixed results on phone visits and patient health. These additional visits come at the sacrifice of new patients: physicians accept 15% fewer new patients each month following e-visit adoption. Our data set on nearly 100,000 patients spans from 2008 to 2013, which includes the rollout and diffusion of e-visits in the health system we study. Identification comes from difference-in-differences estimates leveraging variation in the timing of e-visit adoption by both patients and providers. We conduct several robustness checks, including matching analyses and an instrumental variable analysis to account for possible time-varying characteristics among patient e-visit adopters.
Collapse
Affiliation(s)
- Hessam Bavafa
- Wisconsin School of Business, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Lorin M Hitt
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Christian Terwiesch
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| |
Collapse
|
11
|
Neves AL, Carter AW, Freise L, Laranjo L, Darzi A, Mayer EK. Impact of sharing electronic health records with patients on the quality and safety of care: a systematic review and narrative synthesis protocol. BMJ Open 2018; 8:e020387. [PMID: 30104310 PMCID: PMC6091908 DOI: 10.1136/bmjopen-2017-020387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/21/2018] [Accepted: 07/12/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Providing patients with access to electronic health records (EHRs) has emerged as a promising solution to improve quality of care and safety. As the efforts to develop and implement EHR-based data sharing platforms mature and scale up worldwide, there is a need to evaluate the impact of these interventions and to weigh their relative risks and benefits, in order to inform evidence-based health policies. The aim of this work is to systematically characterise and appraise the demonstrated benefits and risks of sharing EHR with patients, by mapping them across the six domains of quality of care of the Institute of Medicine (IOM) analytical framework (ie, patient-centredness, effectiveness, efficiency, timeliness, equity and safety). METHODS AND ANALYSIS CINAHL, Cochrane, Embase, HMIC, Medline/PubMed and PsycINFO databases will be searched from January 1997 to August 2017. Primary outcomes will include measures related with the six domains of quality of care of the IOM analytical framework. The quality of the studies will be assessed using the Cochrane Risk of Bias Tool, the ROBINS-I Tool and the Drummond's checklist. A narrative synthesis will be conducted for all included studies. Subgroup analysis will be performed by domain of quality of care domain and by time scale (ie, short-term, medium-term or long-term impact). The body of evidence will be summarised in a Summary of Findings table and its strength assessed according to the GRADE criteria. ETHICS AND DISSEMINATION This review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated widely through peer-reviewed publication and conference presentations, and patient partners will be included in summarising the research findings into lay summaries and reports. PROSPERO REGISTRATION NUMBER CRD42017070092.
Collapse
Affiliation(s)
- Ana Luisa Neves
- Center for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Alexander W Carter
- Center for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Lisa Freise
- Center for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Liliana Laranjo
- Australian Institute of Health Innovation, Centre for Health Informatics, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Ara Darzi
- Center for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik K Mayer
- Center for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| |
Collapse
|
12
|
Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06200] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundThere is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood about how, under what conditions, for which patients and in what ways these approaches may offer benefits to patients and practitioners in general practice.ObjectivesOur objectives were to review existing evidence about alternatives to face-to-face consultation; conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives; recruit eight general practices as case studies for focused ethnographic research, exploring how practice context, patient characteristics, type of technology and the purpose of the consultation interact to determine the impact of these alternatives; and synthesise the findings in order to develop a website resource about the implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.DesignMixed-methods case study.SettingGeneral practices in England and Scotland with varied experience of implementing alternatives to face-to-face consultations.ParticipantsPatients and practice staff.InterventionsAlternatives to face-to-face consultations include telephone consultations, e-mail, e-consultations and internet video.Main outcome measuresHow context influenced the implementation and impact of alternatives to the face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of consultation by different patient groups; and the intended benefits/outcomes.Review methodsThe conceptual review used an approach informed by realist review, a method for synthesising research evidence regarding complex interventions.ResultsAlternatives to the face-to-face consultation are not in mainstream use in general practice, with low uptake in our case study practices. We identified the underlying rationales for the use of these alternatives and have shown that different stakeholders have different perspectives on what they hope to achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life use of different forms of alternative, we have a clearer understanding of how, under what circumstances and for which patients alternatives might have a range of intended benefits and potential unintended adverse consequences. We have also developed a framework for future evaluation.LimitationsThe low uptake of alternatives to the face-to-face consultation means that our research participants might be deemed to be early adopters. The case study approach provides an in-depth examination of a small number of sites, each using alternatives in different ways. The findings are therefore hypothesis-generating, rather than hypothesis-testing.ConclusionsThe current low uptake of alternatives, lack of clarity about purpose and limited evidence of benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted key issues for practices and policy-makers to consider and have made recommendations about priorities for further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face consultation, such as telephone consulting, e-consultation, e-mail and video consulting.Future workWe have synthesised our findings to develop a framework and recommendations about future evaluation of the use of alternatives to face-to-face consultations.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| |
Collapse
|
13
|
Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. Alternatives to the face-to-face consultation in general practice: focused ethnographic case study. Br J Gen Pract 2018; 68:e293-e300. [PMID: 29378697 PMCID: PMC5863684 DOI: 10.3399/bjgp18x694853] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. AIM To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. DESIGN AND SETTING Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. METHOD Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. RESULTS Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. CONCLUSION Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.
Collapse
Affiliation(s)
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - John Campbell
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol
| |
Collapse
|
14
|
Edwards HB, Marques E, Hollingworth W, Horwood J, Farr M, Bernard E, Salisbury C, Northstone K. Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England. BMJ Open 2017; 7:e016901. [PMID: 29167106 PMCID: PMC5701981 DOI: 10.1136/bmjopen-2017-016901] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Evaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use. DESIGN 15-month observational study. SETTING Primary care practices in South West England. RESULTS 36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an 'e-consultation' (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30-50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice's response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed. CONCLUSIONS Use of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.
Collapse
Affiliation(s)
- Hannah B Edwards
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elsa Marques
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michelle Farr
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Northstone
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
15
|
Voruganti T, Grunfeld E, Jamieson T, Kurahashi AM, Lokuge B, Krzyzanowska MK, Mamdani M, Moineddin R, Husain A. My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer. J Med Internet Res 2017; 19:e219. [PMID: 28720558 PMCID: PMC5539387 DOI: 10.2196/jmir.7421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. OBJECTIVE The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. METHODS We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ≥3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. RESULTS Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. CONCLUSIONS The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. TRIAL REGISTRATION ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb).
Collapse
Affiliation(s)
- Teja Voruganti
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
16
|
Lee SA, Zuercher RJ. A current review of doctor–patient computer-mediated communication. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17538068.2017.1282184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Seungcheol Austin Lee
- Department of Communication, Northern Kentucky University, 434 Griffin Hall, Highland Heights, KY 41099, USA
| | - Robert J. Zuercher
- Office of Institutional Research and Assessment, University of Alabama, AL, USA
| |
Collapse
|
17
|
Hoonakker PLT, Carayon P, Cartmill RS. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study. Int J Med Inform 2017; 100:63-76. [PMID: 28241939 DOI: 10.1016/j.ijmedinf.2017.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. METHODS We used a multiple case study design with multiple data collections methods (observation, interviews and survey). RESULTS Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. CONCLUSION Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used.
Collapse
Affiliation(s)
- Peter L T Hoonakker
- Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA.
| | - Pascale Carayon
- Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Randi S Cartmill
- Department of Surgery, University of Wisconsin-Madison, K6/117 s Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| |
Collapse
|
18
|
Dash J, Haller DM, Sommer J, Junod Perron N. Use of email, cell phone and text message between patients and primary-care physicians: cross-sectional study in a French-speaking part of Switzerland. BMC Health Serv Res 2016; 16:549. [PMID: 27716256 PMCID: PMC5051025 DOI: 10.1186/s12913-016-1776-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 09/21/2016] [Indexed: 12/13/2022] Open
Abstract
Background Physicians’ daily work is increasingly affected by the use of emails, text messages and cell phone calls with their patients. The aim of this study was to describe their use between primary-care physicians and patients in a French-speaking part of Switzerland. Methods A cross-sectional mail survey was conducted among all primary-care physicians of Geneva canton (n = 636). The questionnaire focused on the frequency of giving access to, type of use, advantages and disadvantages of email, cell phone calls and text messages communication between physicians and patients. Results Six hundred thirty-six questionnaires were mailed, 412 (65 %) were returned and 372 (58 %) could be analysed (37 refusals and three blanks). Seventy-two percent physicians gave their email-address and 74 % their cell phone number to their patients. Emails were used to respond to patients’ questions (82 %) and change appointments (72 %) while cell phone calls and text messages were used to follow patients’ health conditions. Sixty-four percent of those who used email communication never discussed the rules for email exchanges, and 54 % did not address confidentiality issues with their patients. Most commonly identified advantages of emails, cell phone calls and text messages were improved relationship with the patient, saving time (for emails) and improving the follow-up (for cell phone and text messages). The main disadvantages included misuse by the patient, interference with private life and lack of reimbursement. Conclusions These tools are widely used by primary-care physicians with their patients. More attention should be paid to confidentiality, documentation and reimbursement when using email communication in order to optimize its use. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1776-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jonathan Dash
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Dagmar M Haller
- Unit of Primary Care Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Johanna Sommer
- Unit of Primary Care Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Noelle Junod Perron
- Division of Primary Care, Department of Community Care, Primary Care and Emergency, Geneva University Hospitals, Geneva, Switzerland. .,Unit of Development and Research in Medical Education, University of Geneva Faculty of Medicine, Geneva, Switzerland.
| |
Collapse
|
19
|
Abstract
A review of the literature underpinning modern triage methodology is presented. The philosophy and history is described prior to a review of triage scoring methodology relevant to modern day practice. The importance of triage is most acute during major incidents and the triage process is highlighted within this framework. Triage has wide-ranging applications throughout medical practice and these are included as part of the discussion.
Collapse
Affiliation(s)
- M. O'Meara
- Porter K, O'Meara M. Academic department of traumatology, University of Birmingham, Vincent Drive, Birmingham
| | - K. Porter
- Porter K, O'Meara M. Academic department of traumatology, University of Birmingham, Vincent Drive, Birmingham,
| | - I. Greaves
- Greaves I, Department of Academic Emergency medicine, James Cook University Hospital, Middlesbrough
| |
Collapse
|
20
|
Email communication at the medical primary–secondary care interface: a qualitative exploration. Br J Gen Pract 2016; 66:e467-73. [DOI: 10.3399/bjgp16x685273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/07/2016] [Indexed: 10/31/2022] Open
|
21
|
Thompson MJ, Reilly JD, Valdez RS. Work system barriers to patient, provider, and caregiver use of personal health records: A systematic review. APPLIED ERGONOMICS 2016; 54:218-242. [PMID: 26851482 DOI: 10.1016/j.apergo.2015.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This review applied a human factors/ergonomics (HF/E) paradigm to assess individual, work system/unit, organization, and external environment factors generating barriers to patient, provider, and informal caregiver personal health record (PHR) use. METHODS The literature search was conducted using five electronic databases for the timeframe January 2000 to October 2013, resulting in 4865 citations. Two authors independently coded included articles (n = 60). RESULTS Fifty-five, ten and five articles reported barriers to patient, provider and caregiver PHR use, respectively. Barriers centered around 20 subfactors. The most frequently noted were needs, biases, beliefs, and mood (n = 35) and technology functions and features (n = 32). CONCLUSIONS The HF/E paradigm was effective in framing the assessment of factors creating barriers to PHR use. Design efforts should address literacy, interoperability, access to health information, and secure messaging. A deeper understanding of the interactions between work systems and the role of organization and external environment factors is required.
Collapse
Affiliation(s)
- Morgan J Thompson
- Psychology Department, The College of William and Mary, Williamsburg, VA 23187, USA.
| | - Jeremiah D Reilly
- Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA.
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA.
| |
Collapse
|
22
|
Mold F, de Lusignan S. Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice. J Pers Med 2015; 5:452-69. [PMID: 26690225 PMCID: PMC4695865 DOI: 10.3390/jpm5040452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/25/2022] Open
Abstract
Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.
Collapse
Affiliation(s)
- Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7TE, UK.
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford GU2 7XH, UK.
| |
Collapse
|
23
|
Meng D, Palen TE, Tsai J, McLeod M, Garrido T, Qian H. Association between secure patient-clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study. BMJ Open 2015; 5:e009557. [PMID: 26553841 PMCID: PMC4654385 DOI: 10.1136/bmjopen-2015-009557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess associations between secure patient-clinician email use and clinical services utilisation over time. DESIGN Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient-clinician email users and non-users for utilisation 1-12 months before and 7-18 months after first email (users) or a randomly assigned index date (non-users). SETTING US integrated healthcare delivery system. PARTICIPANTS 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. PRIMARY OUTCOME MEASURES Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. RESULTS After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88-237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI -0.3 to -0.1), from a mean of 4.1 calls per person 1-12 months before first use to a mean of 3.8 calls per person 7-18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI -0.2 to 0.0), from a mean of 4.2 calls per person 1-12 months before the index date to mean of 4.1 calls per person 7-18 months after the index date. CONCLUSIONS Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7-18 months after first use.
Collapse
Affiliation(s)
- Di Meng
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Joanne Tsai
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Melanie McLeod
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Terhilda Garrido
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Heather Qian
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| |
Collapse
|
24
|
Bergmo TS. How to Measure Costs and Benefits of eHealth Interventions: An Overview of Methods and Frameworks. J Med Internet Res 2015; 17:e254. [PMID: 26552360 PMCID: PMC4642791 DOI: 10.2196/jmir.4521] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/11/2015] [Accepted: 10/09/2015] [Indexed: 11/13/2022] Open
Abstract
Information on the costs and benefits of eHealth interventions is needed, not only to document value for money and to support decision making in the field, but also to form the basis for developing business models and to facilitate payment systems to support large-scale services. In the absence of solid evidence of its effects, key decision makers may doubt the effectiveness, which, in turn, limits investment in, and the long-term integration of, eHealth services. However, it is not realistic to conduct economic evaluations of all eHealth applications and services in all situations, so we need to be able to generalize from those we do conduct. This implies that we have to select the most appropriate methodology and data collection strategy in order to increase the transferability across evaluations. This paper aims to contribute to the understanding of how to apply economic evaluation methodology in the eHealth field. It provides a brief overview of basic health economics principles and frameworks and discusses some methodological issues and challenges in conducting cost-effectiveness analysis of eHealth interventions. Issues regarding the identification, measurement, and valuation of costs and benefits are outlined. Furthermore, this work describes the established techniques of combining costs and benefits, presents the decision rules for identifying the preferred option, and outlines approaches to data collection strategies. Issues related to transferability and complexity are also discussed.
Collapse
Affiliation(s)
- Trine Strand Bergmo
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsoe, Norway.
| |
Collapse
|
25
|
Cronin RM, Fabbri D, Denny JC, Jackson GP. Automated Classification of Consumer Health Information Needs in Patient Portal Messages. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1861-70. [PMID: 26958285 PMCID: PMC4765690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients have diverse health information needs, and secure messaging through patient portals is an emerging means by which such needs are expressed and met. As patient portal adoption increases, growing volumes of secure messages may burden healthcare providers. Automated classification could expedite portal message triage and answering. We created four automated classifiers based on word content and natural language processing techniques to identify health information needs in 1000 patient-generated portal messages. Logistic regression and random forest classifiers detected single information needs well, with area under the curves of 0.804-0.914. A logistic regression classifier accurately found the set of needs within a message, with a Jaccard index of 0.859 (95% Confidence Interval: (0.847, 0.871)). Automated classification of consumer health information needs expressed in patient portal messages is feasible and may allow direct linking to relevant resources or creation of institutional resources for commonly expressed needs.
Collapse
Affiliation(s)
| | - Daniel Fabbri
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua C Denny
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
26
|
Mirsky JB, Tieu L, Lyles C, Sarkar U. A Mixed-Methods Study of Patient-Provider E-Mail Content in a Safety-Net Setting. JOURNAL OF HEALTH COMMUNICATION 2015; 21:85-91. [PMID: 26332306 PMCID: PMC5431571 DOI: 10.1080/10810730.2015.1033118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To explore the content of patient-provider e-mails in a safety-net primary care clinic, we conducted a content analysis using inductive and deductive coding of e-mail exchanges (n = 31) collected from January through November 2013. Participants were English-speaking adult patients with a chronic condition (or their caregivers) cared for at a single publicly funded general internal medicine clinic and their primary care providers (attending general internist physicians, clinical fellows, internal medicine residents, and nurse practitioners). All e-mails were nonurgent. Patients included a medical update in 19% of all e-mails. Patients requested action in 77% of e-mails, and the most common requests overall were for action regarding medications or treatment (29%). Requests for information were less common (45% of e-mails). Patient requests (n = 56) were resolved in 84% of e-mail exchanges, resulting in 63 actions. These results show that patients in safety-net clinics are capable of safely and effectively using electronic messaging for between-visit communication with providers. Safety-net systems should implement electronic communications tools as soon as possible to increase health care access and enhance patients' involvement in their care.
Collapse
Affiliation(s)
- Jacob B Mirsky
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Lina Tieu
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Courtney Lyles
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Urmimala Sarkar
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| |
Collapse
|
27
|
Uneke CJ, Ezeoha AE, Uro-Chukwu H, Ezeonu CT, Ogbu O, Onwe F, Edoga C. Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop. Pan Afr Med J 2015; 21:212. [PMID: 26448807 PMCID: PMC4587084 DOI: 10.11604/pamj.2015.21.212.6375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/01/2015] [Indexed: 11/24/2022] Open
Abstract
Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers’ ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.
Collapse
Affiliation(s)
- Chigozie Jesse Uneke
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki, Nigeria ; Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria
| | - Abel Ebeh Ezeoha
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Banking & Finance, Ebonyi State University Abakaliki, Nigeria
| | - Henry Uro-Chukwu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; National Obstetrics Fistula Centre, Abakaliki, Nigeria
| | - Chinonyelum Thecla Ezeonu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Paediatrics, Ebonyi State University Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki, Nigeria ; Department of Applied Microbiology, Ebonyi State University Abakaliki, Nigeria
| | - Friday Onwe
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Sociology/Anthropology, Ebonyi State University Abakaliki, Nigeria
| | - Chima Edoga
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Catholic Relief Services (Nigeria Program), Abakaliki, Nigeria
| |
Collapse
|
28
|
Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties. Appl Clin Inform 2015; 6:288-304. [PMID: 26171076 DOI: 10.4338/aci-2014-12-ra-0117] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/03/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and healthcare providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment. METHODS This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties. RESULTS Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of outpatient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001). CONCLUSIONS This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.
Collapse
Affiliation(s)
- R M Cronin
- Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Medicine , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee
| | - S E Davis
- Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee
| | - J A Shenson
- Vanderbilt University Medical Center School of Medicine , Nashville, Tennessee
| | - Q Chen
- Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Biostatistics , Nashville, Tennessee
| | - S T Rosenbloom
- Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Medicine , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee
| | - G P Jackson
- Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatric Surgery , Nashville, Tennessee
| |
Collapse
|
29
|
Pattison N, O'Gara G, Rattray J. After critical care: patient support after critical care. A mixed method longitudinal study using email interviews and questionnaires. Intensive Crit Care Nurs 2015; 31:213-22. [PMID: 25748475 DOI: 10.1016/j.iccn.2014.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/06/2014] [Accepted: 12/28/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To explore experiences and needs over time, of patients discharged from ICU using the Intensive Care Experience (ICE-q) questionnaire, Hospital Anxiety and Depression Scale (HADS) and EuroQoL (EQ-5D), associated clinical predictors (APACHE II, TISS, Length of stay, RIKER scores) and in-depth email interviewing. METHODS A mixed-method, longitudinal study of patients with >48hour ICU stays at 2 weeks, 6 months, 12 months using the ICE-q, HADS, EQ-5D triangulated with clinical predictors, including age, gender, length of stay (ICU and hospital), APACHE II and TISS. In-depth qualitative email interviews were completed at 1 month and 6 months. Grounded Theory analysis was applied to interview data and data were triangulated with questionnaire and clinical data. RESULTS Data was collected from January 2010 to March 2012 from 77 participants. Both mean EQ-5D visual analogue scale, utility scores and HADS scores improved from 2 weeks to 6 months, (p=<0.001; p=<0.001), but between 6 and 12 months, no change was found in data from either questionnaire, suggesting improvements level off. These variations were reflected in qualitative data themes: rehabilitation/recovery in the context of chronic illness; impact of critical care; emotional and psychological needs (including sub-themes of: information needs and relocation anxiety). The overarching, core theme related to adjustment of normality. CONCLUSIONS Patient recovery in this population appears to be shaped by ongoing illness and treatment. Email interviews offer a convenient method of gaining in-depth interview data and could be used as part of ICU follow-up.
Collapse
Affiliation(s)
- Natalie Pattison
- The Royal Marsden NHS Foundation Trust, Fulham Road, London Sw36JJ, UK.
| | - Geraldine O'Gara
- The Royal Marsden NHS Foundation Trust, Fulham Road, London Sw36JJ, UK. geraldine.o'
| | - Janice Rattray
- The University of Dundee, School of Nursing & Midwifery, 11 Airlie Place, Dundee DD1 4HJ, UK.
| |
Collapse
|
30
|
Mold F, de Lusignan S, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M, Franco C, Chauhan U, Blakey H, Kataria N, Arvanitis TN, Ellis B. Patients' online access to their electronic health records and linked online services: a systematic review in primary care. Br J Gen Pract 2015; 65:e141-51. [PMID: 25733435 PMCID: PMC4337302 DOI: 10.3399/bjgp15x683941] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/01/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. AIM To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. DESIGN AND SETTING A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. METHOD Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. RESULTS A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. CONCLUSION While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.
Collapse
Affiliation(s)
- Freda Mold
- Integrated care, University of Surrey, Guildford
| | | | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh
| | | | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Tom Quinn
- Health and Medical Strategy, University of Surrey, Guildford
| | - Mary Cavill
- Clinical Innovation and Research Centre, Royal College of General Practitioners, London
| | | | | | - Hannah Blakey
- Academic Primary Care Foundation Programme Doctor, St George's Hospital, London
| | | | | | | |
Collapse
|
31
|
Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of "eVisits" in acute primary care delivery. Telemed J E Health 2014; 21:90-6. [PMID: 25474083 DOI: 10.1089/tmj.2014.0022] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or "eVisits," allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. MATERIALS AND METHODS A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. RESULTS Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. CONCLUSIONS Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction.
Collapse
Affiliation(s)
- Ryan Hickson
- 1 College of Pharmacy, University of Kentucky , Lexington, Kentucky
| | | | | | | | | |
Collapse
|
32
|
de Lusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M, Gronlund TA, Franco C, Chauhan U, Blakey H, Kataria N, Barker F, Ellis B, Koczan P, Arvanitis TN, McCarthy M, Jones S, Rafi I. Patients' online access to their electronic health records and linked online services: a systematic interpretative review. BMJ Open 2014; 4:e006021. [PMID: 25200561 PMCID: PMC4158217 DOI: 10.1136/bmjopen-2014-006021] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/11/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. SETTING Primary care. PARTICIPANTS A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. RESULTS No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. CONCLUSIONS Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.
Collapse
Affiliation(s)
- Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Freda Mold
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mary Cavill
- The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK
| | | | | | - Umesh Chauhan
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Neha Kataria
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Fiona Barker
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Beverley Ellis
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Mary McCarthy
- Belvidere Medical Practice, Shrewsbury, Shropshire, UK
| | - Simon Jones
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Imran Rafi
- The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK
| |
Collapse
|
33
|
Plener I, Hayward A, Saibil F. E-mail communication in the management of gastroenterology patients: a review. Can J Gastroenterol Hepatol 2014; 28:161-5. [PMID: 24619639 PMCID: PMC4071874 DOI: 10.1155/2014/764538] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
Abstract
E-mail correspondence between physicians and patients can be a useful tool to improve communication efficiency, provide economic and ecological benefits, improve therapeutic interventions and adherence, and enhance self-management. The model of self-management in chronic disease has become an integral component of North American and British medicine. From a practical standpoint, the use of e-mail between physicians and patients can complement the self-management model. E-mail communication has many benefits from both patient and physician perspectives. E-mail contact reduces the inefficiencies associated with telecommunications. Physicians are able to better document out-of-office patient encounters and provide access to specialist care for patients in remote locations. This use of e-mail has the potential to increase patient safety through physician approval of self-manager actions, including earlier initiation of needed treatments. Fewer clinic visits afford additional time for new consultations and sicker patients, reducing the overall burden on referral and wait times. The present article reviews some of the literature regarding physician-patient e-mail communication in the general ambulatory setting, in the context of chronic disease and with a specific focus on inflammatory bowel disease (IBD). The authors provide a framework for the use of e-mail communication in the IBD population, with emphasis on the concept of e-mail use. Also illustrated are the benefits and disadvantages, and examples of the e-mail contract as proposed by the Canadian Medical Protective Association. Examples of specific e-mail communication topics are provided for several IBD scenarios. Potential negative consequences of this mode of communication are also discussed.
Collapse
Affiliation(s)
- Ian Plener
- Department of Medicine, University of Toronto, Toronto, Ontario
| | - Andrew Hayward
- Department of Medicine, University of Toronto, Toronto, Ontario
| | - Fred Saibil
- Department of Medicine, University of Toronto, Toronto, Ontario
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| |
Collapse
|
34
|
Varsi C, Gammon D, Wibe T, Ruland CM. Patients' reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study. J Med Internet Res 2013; 15:e246. [PMID: 24220233 PMCID: PMC3841351 DOI: 10.2196/jmir.2683] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 09/11/2013] [Accepted: 10/07/2013] [Indexed: 11/18/2022] Open
Abstract
Background The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).
Collapse
Affiliation(s)
- Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
| | | | | | | |
Collapse
|
35
|
Oakley M, Horvath Z, Weinberg SM, Bhatt J, Spallek H. Comparison of E-Mail Communication Skills Among First- and Fourth-Year Dental Students. J Dent Educ 2013. [DOI: 10.1002/j.0022-0337.2013.77.11.tb05617.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marnie Oakley
- Department of Restorative Dentistry and Comprehensive Care; University of Pittsburgh School of Dental Medicine
| | - Zsuzsa Horvath
- Office of Faculty Affairs; University of Pittsburgh School of Dental Medicine
| | - Seth M. Weinberg
- Department of Oral Biology; University of Pittsburgh School of Dental Medicine
| | | | - Heiko Spallek
- Faculty Affairs and Associate Professor, Department of Dental Public Health; University of Pittsburgh School of Dental Medicine
| |
Collapse
|
36
|
ICT and collaborative management of terminal cancer patients at the University College Hospital, Ibadan, Nigeria. HEALTH AND TECHNOLOGY 2013. [DOI: 10.1007/s12553-013-0063-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
37
|
Atherton H, Sawmynaden P, Sheikh A, Majeed A, Car J. Email for clinical communication between patients/caregivers and healthcare professionals. Cochrane Database Syst Rev 2012; 11:CD007978. [PMID: 23152249 DOI: 10.1002/14651858.cd007978.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Email is a popular and commonly-used method of communication, but its use in health care is not routine. Where email communication has been demonstrated in health care this has included its use for communication between patients/caregivers and healthcare professionals for clinical purposes, but the effects of using email in this way is not known.This review addresses the use of email for two-way clinical communication between patients/caregivers and healthcare professionals. OBJECTIVES To assess the effects of healthcare professionals and patients using email to communicate with each other, on patient outcomes, health service performance, service efficiency and acceptability. SEARCH METHODS We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010) and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors. SELECTION CRITERIA Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions using email to allow patients to communicate clinical concerns to a healthcare professional and receive a reply, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias of included studies and extracted data. We contacted study authors for additional information. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous measures, we report effect sizes as mean differences (MD). For dichotomous outcome measures, we report effect sizes as odds ratios and rate ratios. Where it was not possible to calculate an effect estimate we report mean values for both intervention and control groups and the total number of participants in each group. Where data are available only as median values it is presented as such. It was not possible to carry out any meta-analysis of the data. MAIN RESULTS We included nine trials enrolling 1733 patients; all trials were judged to be at risk of bias. Seven were randomised controlled trials; two were cluster-randomised controlled designs. Eight examined email as compared to standard methods of communication. One compared email with telephone for the delivery of counselling. When email was compared to standard methods, for the majority of patient/caregiver outcomes it was not possible to adequately assess whether email had any effect. For health service use outcomes it was not possible to adequately assess whether email has any effect on resource use, but some results indicated that an email intervention leads to an increased number of emails and telephone calls being received by healthcare professionals. Three studies reported some type of adverse event but it was not clear if the adverse event had any impact on the health of the patient or the quality of health care. When email counselling was compared to telephone counselling only patient outcomes were measured, and for the majority of measures there was no difference between groups. Where there were differences these showed that telephone counselling leads to greater change in lifestyle modification factors than email counselling. There was one outcome relating to harm, which showed no difference between the email and the telephone counselling groups. There were no primary outcomes relating to healthcare professionals for either comparison. AUTHORS' CONCLUSIONS The evidence base was found to be limited with variable results and missing data, and therefore it was not possible to adequately assess the effect of email for clinical communication between patients/caregivers and healthcare professionals. Recommendations for clinical practice could not be made. Future research should ideally address the issue of missing data and methodological concerns by adhering to published reporting standards. The rapidly changing nature of technology should be taken into account when designing and conducting future studies and barriers to trial development and implementation should also be tackled. Potential outcomes of interest for future research include cost-effectiveness and health service resource use.
Collapse
Affiliation(s)
- Helen Atherton
- Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
| | | | | | | | | |
Collapse
|
38
|
BURKE-BEBEE SUZIE, WILSON MARISA, BUCKLEY KATHLEENM. Building Health Information Technology Capacity. Comput Inform Nurs 2012; 30:547-53. [DOI: 10.1097/nxn.0b013e318261fc3a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
LaVela SL, Schectman G, Gering J, Locatelli SM, Gawron A, Weaver FM. Understanding health care communication preferences of veteran primary care users. PATIENT EDUCATION AND COUNSELING 2012; 88:420-426. [PMID: 22766452 DOI: 10.1016/j.pec.2012.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/18/2012] [Accepted: 06/08/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess veterans' health communication preferences (in-person, telephone, or electronic) for primary care needs and the impact of computer use on preferences. METHODS Structured patient interviews (n=448). Bivariate analyses examined preferences for primary care by 'infrequent' vs. 'regular' computer users. RESULTS Only 54% were regular computer users, nearly all of whom had ever used the internet. 'Telephone' was preferred for 6 of 10 reasons (general medical questions, medication questions and refills, preventive care reminders, scheduling, and test results); although telephone was preferred by markedly fewer regular computer users. 'In-person' was preferred for new/ongoing conditions/symptoms, treatment instructions, and next care steps; these preferences were unaffected by computer use frequency. Among regular computer users, 1/3 preferred 'electronic' for preventive reminders (37%), test results (34%), and refills (32%). CONCLUSION For most primary care needs, telephone communication was preferred, although by a greater proportion of infrequent vs. regular computer users. In-person communication was preferred for reasons that may require an exam or visual instructions. About 1/3 of regular computer users prefer electronic communication for routine needs, e.g., preventive reminders, test results, and refills. PRACTICE IMPLICATIONS These findings can be used to plan patient-centered care that is aligned with veterans' preferred health communication methods.
Collapse
Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Meyer B, Atherton H, Sawmynaden P, Car J. Email for communicating results of diagnostic medical investigations to patients. Cochrane Database Syst Rev 2012:CD007980. [PMID: 22895970 DOI: 10.1002/14651858.cd007980.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare providers to convey increasing volumes of test results to patients is driving investigation of alternative technological solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical investigations to patients. OBJECTIVES To assess the effects of using email for communicating results of diagnostic medical investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes, including harms, for health professionals, patients and caregivers, and health services. SEARCH METHODS We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors. SELECTION CRITERIA Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions using email for communicating results of any diagnostic medical investigations to patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible. MAIN RESULTS No studies met the inclusion criteria, therefore there are no results to report on the use of email for communicating results of diagnostic medical investigations to patients. AUTHORS' CONCLUSIONS In the absence of included studies, we can draw no conclusions on the effects of using email for communicating results of diagnostic medical investigations to patients, and thus no recommendations for practice can be stipulated. Further well-designed research should be conducted to inform practice and policy for communicating patient results via email, as this is a developing area.
Collapse
Affiliation(s)
- Barbara Meyer
- General Practice, NHS Education for Scotland, Glasgow, UK.
| | | | | | | |
Collapse
|
41
|
Wakefield DS, Kruse RL, Wakefield BJ, Koopman RJ, Keplinger LE, Canfield SM, Mehr DR. Consistency of patient preferences about a secure Internet-based patient communications portal: contemplating, enrolling, and using. Am J Med Qual 2012; 27:494-502. [PMID: 22517909 DOI: 10.1177/1062860611436246] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internet-based secure communication portals (portal) have the potential to enhance patient care via improved patient-provider communications. This study examines differences among primary care patients' perceptions when contemplating using, enrolling to use, and using a portal for health care purposes. A total of 3 groups of patients from 1 Midwestern academic medical center were surveyed at different points in time: (1) Waiting Room survey asking about hypothetical interest in using a portal to communicate with their physicians; (2) patient portal Enrollment survey; and (3) Follow-up postenrollment experience survey. Those who enroll and use a patient portal have different demographic characteristics and interest levels in selected portal functions (eg, e-mailing providers, viewing medical records online, making appointments) and initially perceive only limited improvements in care because of the portal. These differences have potential market implications and provide insight into selecting and maintaining portal functions of greater interest to patients who use the portal.
Collapse
|
42
|
Wallwiener M, Wallwiener CW, Kansy JK, Seeger H, Rajab TK. Impact of electronic messaging on the patient-physician interaction. J Telemed Telecare 2012; 15:243-50. [PMID: 19590030 DOI: 10.1258/jtt.2009.090111] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients are interested in secure electronic communication with their health-care providers, but physicians have been slow to adopt the technique into their practice. We have therefore reviewed the literature on secure patient messaging. Relevant studies were identified by Medline search which produced 1065 publications. Of these, 71 relevant articles were read independently by two reviewers. Currently available messaging systems allow for asynchronous communication, physician reimbursement and automated supporting functions such as triaging of patient messages and integration of messaging into medical records. The review showed that patients are satisfied with the use of secure physician messaging systems and find such services to be convenient, time-saving and useful. Physicians do not report adverse effects from their use. Legal concerns with electronic messaging include compliance with privacy standards. The economic benefits of secure messaging systems are most immediately apparent for larger health-care groups and hospitals, although smaller practices will also benefit in the long run. Secure patient-physician messaging is a convenient and useful addition to the health-care infrastructure. It can be expected that the identification of secure providers, integration with reimbursement systems and initial uptake by larger health-care organizations will speed up the adoption into routine health care.
Collapse
Affiliation(s)
- Markus Wallwiener
- Universitaetsfrauenklinik Hospital, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany.
| | | | | | | | | |
Collapse
|
43
|
Finkelstein J, Barr MS, Kothari PP, Nace DK, Quinn M. Patient-centered medical home cyberinfrastructure current and future landscape. Am J Prev Med 2011; 40:S225-33. [PMID: 21521598 DOI: 10.1016/j.amepre.2011.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/14/2011] [Accepted: 01/28/2011] [Indexed: 11/19/2022]
Abstract
The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.
Collapse
Affiliation(s)
- Joseph Finkelstein
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
44
|
Albert SM, Shevchik GJ, Paone S, Martich GD. Internet-based medical visit and diagnosis for common medical problems: experience of first user cohort. Telemed J E Health 2011; 17:304-8. [PMID: 21457013 DOI: 10.1089/tmj.2010.0156] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Internet-based medical visits, or "structured e-Visits," allow patients to report symptoms and seek diagnosis and treatment from their doctor over a secure Web site, without calling or visiting the physician's office. While acceptability of e-Visits has been investigated, outcomes associated with e-Visits, that is, whether patients receiving diagnoses receive appropriate care or need to return to the doctor, remain unexplored. MATERIALS AND METHODS The first 156 e-Visit users from a large family medicine practice were surveyed regarding their experience with the e-Visit and e-Visit outcomes. In addition, medical records for patients making e-Visits were reviewed to examine need for follow-up care within 7 days. RESULTS Interviews were completed with 121 patients (77.6% participation). The most common type of e-Visit was for "other" symptoms or concerns (37%), followed by sinus/cold symptoms (35%). Back pain, urinary symptoms, cough, diarrhea, conjunctivitis, and vaginal irritation were each less frequent (<10%). A majority, 61% completed e-Visits with their own physician. The majority of patients (57.0%) reported receipt of a diagnosis without need for follow-up beyond a prescription; 75% of patients thought the e-Visit was as good as or better than an in-person visit, and only 11.6% felt that their concerns or questions were incompletely addressed. In a review of medical records, 16.9% had a follow-up visit within 7 days, mostly for the same condition. Four of these were on the same day as the e-Visit, including one emergency department visit. CONCLUSIONS Outcomes for the e-Visit suggest that it is an appropriate and potentially cost-saving addition to in-person delivery of primary care.
Collapse
Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
| | | | | | | |
Collapse
|
45
|
Mittal MK, Dhuper S, Siva C, Fresen JL, Petruc M, Velázquez CR. Assessment of email communication skills of rheumatology fellows: a pilot study. J Am Med Inform Assoc 2010; 17:702-6. [PMID: 20962134 PMCID: PMC3000755 DOI: 10.1136/jamia.2010.004556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 09/02/2010] [Indexed: 01/22/2023] Open
Abstract
Physician-patient email communication is gaining popularity. However, a formal assessment of physicians' email communication skills has not been described. We hypothesized that the email communication skills of rheumatology fellows can be measured in an objective structured clinical examination (OSCE) setting using a novel email content analysis instrument which has 18 items. During an OSCE, we asked 50 rheumatology fellows to respond to a simulated patient email. The content of the responses was assessed using our instrument. The majority of rheumatology fellows wrote appropriate responses scoring a mean (±SD) of 10.6 (±2.6) points (maximum score 18), with high inter-rater reliability (0.86). Most fellows were concise (74%) and courteous (68%) but not formal (22%). Ninety-two percent of fellows acknowledged that the patient's condition required urgent medical attention, but only 30% took active measures to contact the patient. No one encrypted their messages. The objective assessment of email communication skills is possible using simulated emails in an OSCE setting. The variable email communication scores and incidental patient safety gaps identified, suggest a need for further training and defined proficiency standards for physicians' email communication skills.
Collapse
Affiliation(s)
- Mayank K Mittal
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Christner JG, Stansfield RB, Schiller JH, Madenci A, Keefer PM, Pituch K. Use of simulated electronic mail (e-mail) to assess medical student knowledge, professionalism, and communication skills. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:S1-S4. [PMID: 20881689 DOI: 10.1097/acm.0b013e3181ed45f8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Physicians communicate with patients using electronic mail (e-mail) with increasing frequency. Communication skills specific to e-mail do not appear to be taught explicitly in medical school. Therefore, the effect of an instructive session on effective e-mail communication was examined. METHOD Four simulated e-mails from a parent were developed. Students responded to an initial e-mail and then participated in a session on effective e-mail communication. Responses to a final e-mail were assessed using a rubric with subscores for medical knowledge, communication, and professionalism. RESULTS Performance improved from the first to final e-mail response in the overall score and in each subscore. Improvement was sustained over the course of the academic year. Interrater reliability revealed good agreement. CONCLUSIONS Communicating effectively with patients via e-mail is not intuitive but can be taught. It is feasible to introduce responses to a simulated e-mail case in a clinical clerkship as an assessment tool.
Collapse
Affiliation(s)
- Jennifer G Christner
- University of Michigan, Department of Pediatrics, Ann Arbor, MI 48109-5718, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
As medical providers seek new ways to control costs, online visits have begun to receive serious consideration. The purpose of this study was to compare the odds of being a cost outlier during a 6-month period after either an online visit or a standard drop-in visit in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who had an online visit (N = 390) and a comparison group who had regular office care for same-day, acute visits (N = 376). Case types were classified as either complex or common, with common being defined as treatment for pinkeye, sore throat, viral illness, bronchitis, or cough. Outliers were defined as patients for whom standard costs exceeded the 75(th) percentile during a 6-month period after the index visit. Multiple logistic regression analysis was used to adjust for differences between groups. The percentage of online visitors who were cost outliers was 21.2 (versus 28.5 in the standard visit group). Median standard costs were $161 for online visits and $219 for same-day acute visits. The adjusted odds of being a cost outlier was lower for the online visit group than for the standard visit group (odds ratio [OR] 0.52, 95% confidence interval [95% CI] 0.35-0.77) after adjusting for number of visits in the previous 6 months, age, sex, and case type. Outpatient visits in the previous 6 months were positively related to outlier status (OR 1.23, 95% CI 1.17-1.29). Online visits appeared to reduce medical costs for patients during a 6-month period after the visit.
Collapse
|
48
|
Ye J, Rust G, Fry-Johnson Y, Strothers H. E-mail in patient-provider communication: a systematic review. PATIENT EDUCATION AND COUNSELING 2010; 80:266-73. [PMID: 19914022 PMCID: PMC4127895 DOI: 10.1016/j.pec.2009.09.038] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 09/03/2009] [Accepted: 09/16/2009] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To review systematically the role of e-mails in patient-provider communication in terms of e-mail content, and perspectives of providers and patients on e-mail communication in health care. METHODS A systematic review of studies on e-mail communication between patients and health providers in regular health care published from 2000 to 2008. RESULTS A total of 24 studies were included in the review. Among these studies, 21 studies examined e-mail communication between patients and providers, and three studies examined the e-mail communication between parents of patients in pediatric primary care and pediatricians. In the content analyses of e-mail messages, topics well represented were medical information exchange, medical condition or update, medication information, and subspecialty evaluation. A number of personal and institutional features were associated with the likelihood of e-mail use between patients and providers. While benefits of e-mails in enhancing communication were recognized by both patients and providers, concerns about confidentiality and security were also expressed. CONCLUSION The e-mail is transforming the relationship between patients and providers. The rigorous exploration of pros and cons of electronic interaction in health care settings will help make e-mail communication a more powerful, mutually beneficial health care provision tool. PRACTICE IMPLICATIONS It is important to develop an electronic communication system for the clinical practice that can address a range of concerns. More efforts need to be made to educate patients and providers to appropriately and effectively use e-mail for communication.
Collapse
Affiliation(s)
- Jiali Ye
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA 30310, USA.
| | | | | | | |
Collapse
|
49
|
Wakefield DS, Mehr D, Keplinger L, Canfield S, Gopidi R, Wakefield BJ, Koopman RJ, Belden JL, Kruse R, Kochendorfer KM. Issues and questions to consider in implementing secure electronic patient-provider web portal communications systems. Int J Med Inform 2010; 79:469-77. [PMID: 20472495 DOI: 10.1016/j.ijmedinf.2010.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/19/2010] [Accepted: 04/21/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients are increasingly interested in using Internet-based technologies to communicate with their providers, schedule clinic visits, request medication refills, and view their medical records electronically. However, healthcare organizations face significant challenges in providing such highly personal and sensitive communication in an effective and user-friendly manner. METHODS Based on the literature and our experience in providing a secure web-based patient-provider communication portal in primary care clinics, a framework was developed that identifies key issues and questions to consider in implementing secure electronic patient-provider communications systems. RESULTS The framework serves to categorize the many lessons learned from our implementation process and the specific issues and questions healthcare organizations need to consider in implementing such systems related to seven areas: strategic fit and priority; selection process & implementation team; integration into communications and workflows; HIPAA issues & clinic policies; systems implementation & training; marketing & enrollment; on-going performance monitoring. CONCLUSION The framework provides a useful guide for organizations looking to implement secure electronic patient-provider communication systems.
Collapse
Affiliation(s)
- Douglas S Wakefield
- Center for Health Care Quality and Department of Health Management and Informatics, University of Missouri, MO 65212, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, Frémont P, Gagnon J, Tremblay N, Légaré F. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2010; 36:241-77. [PMID: 20703721 DOI: 10.1007/s10916-010-9473-4] [Citation(s) in RCA: 283] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/08/2010] [Indexed: 01/18/2023]
Abstract
This systematic review of mixed methods studies focuses on factors that can facilitate or limit the implementation of information and communication technologies (ICTs) in clinical settings. Systematic searches of relevant bibliographic databases identified studies about interventions promoting ICT adoption by healthcare professionals. Content analysis was performed by two reviewers using a specific grid. One hundred and one (101) studies were included in the review. Perception of the benefits of the innovation (system usefulness) was the most common facilitating factor, followed by ease of use. Issues regarding design, technical concerns, familiarity with ICT, and time were the most frequent limiting factors identified. Our results suggest strategies that could effectively promote the successful adoption of ICT in healthcare professional practices.
Collapse
|