Pilot Study of Providing Online Care in a Primary Care Setting

Adamson, Steven c.; Bachman, John w.

doi:10.4016/18407.01

Cited by 15 publications

(23 citation statements)

References 17 publications

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“…Interestingly, these were mainly reported before the timeframe of our review, suggesting a loss of research interest for unclear reasons 35. Several recent studies have examined automated patient interviewing in specialised settings including home,36 emergency department waiting rooms37 38 and online visits in primary care 39. One study found that physician-acquired history and computer-based systems each elicited important information that the other missed,40 reaffirming the role of technology in complementing rather than replacing the physician-acquired history.…”

Section: Resultsmentioning

confidence: 99%

Use of health information technology to reduce diagnostic errors

2013

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BackgroundHealth information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions.Methods A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified.ResultsHIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact.ConclusionsDiagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.

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Section: Resultsmentioning

confidence: 99%

Use of health information technology to reduce diagnostic errors

2013

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“…Overall use was judged by clinicians to be appropriate with a minority of e-consultations resulting in a subsequent face-to-face encounter (n=3 studies) 34 85 110. After an early peak in email volume there is some evidence that the level falls back 127.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies outlined a number of novel technologies that had been introduced including providing links to X-ray and scan images34 70 98; automated test result tracking,80 text messaging question and answer service125; portals that use a code number or pictures of medications to avoid medication names being displayed41; and web-based triage 36. Many of the portals were carefully designed to deliver full or partial online access87 96 and some required complex technical development linking different systems, for example to provide access to pathology results and X-ray reports or images 70 98.…”

Section: Resultsmentioning

confidence: 99%

Patients’ online access to their electronic health records and linked online services: a systematic interpretative review

et al. 2014

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ObjectivesTo 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.SettingPrimary care.ParticipantsA 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 measuresOur primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.ResultsNo 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.ConclusionsPatient 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 numberPROSPERO CRD42012003091.

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“…16,17,18 This study evaluated the feasibility and scope of de novo real-time primary care and urgent care-type visits delivered via a voice-and-video-over-Internet protocol. We were able to assess the feasibility of this type of online visit by answering several questions through this descriptive study: the demographic characteristics of patients using online visits in a community setting; the self-selected scope of care for which patients schedule a visit; the ability of healthcare professionals to successfully complete online visits and comply with protocols for these types of visits; the utilization of laboratory tests, radiology studies and prescriptions written during these visits; and the proportion of online visits that trigger recommendations for in-person visits based on protocols or providers' clinical judgment or need for a hands-on physical exam.…”

Section: Discussionmentioning

confidence: 99%

“…13 To our knowledge, all prior studies of telemedicine have analyzed encounters with established patients, or those in which a provider or trained individual acts as an intermediary between the patient and another provider, 14,15 or the use of highly structured, asynchronous e-visits through a patient portal. [16][17][18] Here we present the first description of the use of multimedia voice and video telemedicine in the provision of real-time primary and urgent care involving direct evaluation of new and return patients who self-initiated first contact with a healthcare provider through online scheduling at a private, neighborhood-based healthcare system in a large urban area.…”

Section: Introductionmentioning

confidence: 99%

Use of a voice and video internet technology as an alternative to in-person urgent care clinic visits

et al. 2015

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This study aimed to determine the feasibility of patient-initiated online Internet urgent care visits, and to describe patient characteristics, scope of care, provider adherence to protocols, and diagnostic and therapeutic utilization. A total of 456 unique patients were seen via Internet-based technology during the study period, generating 478 consecutive total patient visits. Of the 82 patients referred for an in-person evaluation, 75 patients (91.5%) reported to the clinic as instructed. None of the 82 patients recommended for in-person evaluation required an emergency department referral, hospital admission or urgent consultative referral. We conclude that real-time online primary and urgent care visits are feasible, safe and potentially beneficial in increasing convenient access to urgent and primary care.

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Pilot Study of Providing Online Care in a Primary Care Setting

Cited by 15 publications

References 17 publications

Use of health information technology to reduce diagnostic errors

Use of health information technology to reduce diagnostic errors

Patients’ online access to their electronic health records and linked online services: a systematic interpretative review

Use of a voice and video internet technology as an alternative to in-person urgent care clinic visits

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