Abstract
Background/Aims: Secure messaging within electronic medical records (EMR) between primary and specialty providers (virtual consults) may lead to streamlined care processes.
Methods: An observational study of the use of traditional consults (TC) and virtual consults (VC) by adult primary care physicians to specialty departments conducted from June 2008 to November 2008. We compiled data for all consult orders made within the EMR. We conducted manual chart reviews, physician and patient surveys on a random selection of consults to determine the reason for the consult, the advice returned, the number of people involved in processing the consult, and the turn -around time for the consult. We report mid-study descriptive statistics on the number of patients with consults, patient demographics, the types of consults, and to which departments. We also report on the number of patient satisfaction surveys attempted and completed.
Results: We identified 33,390 consult orders (93.6% TC, 6.4% VC) for 27,932 patients with ages ranging from 18 to 99 (mean 53.95). Of these patients, 83.8% had one, 13.5% had two, and 2.7% had three or more consult orders. The top departments for TC were: Physical Therapy (29.2%), Orthopedics (11.9%), Cardiology (11.2%), General Surgery (8.8%), and Dermatology (8.3%). The top departments for VC were: Dermatology (18.3%), Neurosurgery (12.3%), Endocrinology (9.6%), Neurology (7.2%), and General Surgery (6.2%). The average response time for VC was 3.2 days (range 130 days) with over 50% returned within one day. We randomly selected 540 patients (equally divided between TC and VC), contacted 340 thus far, and 154 participated in the survey. Forty percent of these patients received VC and 67% of these patients eventually saw a specialist. Of all patients surveyed, 79.4% were satisfied with the specialist recommendations (not significantly different between consult types).
Conclusions: The primary care providers use virtual consults for different purposes than traditional consults. Physician and patient surveys and chart reviews are scheduled for completion in 2009 allowing a full comparison of virtual consults to traditional consults from multiple perspectives. If effective, virtual consults may improve patient satisfaction and streamline the care delivery process.
