Abstract
Background/Aims: Shared Electronic Medical Record (EMR) systems could increase communication between primary and specialty care. Electronic (virtual) EMR consults (VC) could streamline patient care. We describe physician use of VCs within Kaiser Permanente’s HealthConnect EMR, compared with traditional requests for consults (TC).
Methods: Prospective, observational, case control study comparing VCs with TCs from Kaiser Colorado adult primary care physicians to several specialty departments. Every 2 weeks from June to November 2008, VCs were randomly selected and matched with TCs by requesting physician specialty, reason for referral, referral department, patient gender and age. Referring physicians were asked to complete an online survey on reason for consult, answers received, if answers met immediate patient care needs, likelihood of using (or actual use of) the information in subsequent patient care, the impact of the consult process on physician work flow, and their overall satisfaction with the consult.
Results: Eighty-two of 205 unique physicians responded on 62 VCs and 49 TCs; overall return rate was 26.4% (30.0% of 207 VCs and 22.9% of 214 TCs). Etiology, screening and evaluation questions were similarly common reasons for both types of consults; requests to initiate treatment or assume care were more common in TCs. Seventy-four percent of physicians requesting VCs and 39% of those requesting TCs received information from the consultant by the time of survey completion; 91% of these physicians used at least some information from the referral in caring for the index patient. Fifteen percent had already used the information in the care of subsequent patients; 41% thought they would likely use the information in the future; 29% thought they would not likely use the information in the future. Sixty percent of physicians who received information were satisfied with the information from the referral, 24% were dissatisfied, with no difference between VCs and TCs.
Conclusions: Referring physicians received information more quickly from VCs than TCs. Consult reasons, use of information received in the index and subsequent patients, and overall satisfaction with information were similar between VCs and TCs. Additional analysis will explore longer term educational outcomes, patient satisfaction, and economic differences between VCs and TCs.
