Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7391.696 (Published 29 March 2003) Cite this as: BMJ 2003;326:696
- Iris Kedar, clinical and research fellow,
- Joseph L Ternullo, associate director,
- Carol E Weinrib, consultant,
- Kathleen M Kelleher, senior online consultation coordinator,
- Heather Brandling-Bennett, medical student,
- Joseph C Kvedar (jkvedar{at}partners.org), director
- Correspondence to: J C Kvedar
- Accepted 20 January 2003
Abstract
Objective: To assess whether transferring knowledge from specialists at centres of excellence to referring doctors through online consultations can improve the management of patients requiring specialised care.
Design: Retrospective case review of the first year of internet based patient initiated consultations between referring doctors and consulting specialists.
Setting: US teaching hospitals affiliated with an organisation providing internet based consultations.
Participants: Doctors in various settings around the world engaging in internet based consultations with specialists.
Main outcome measures: New recommendations for treatment, change in diagnosis, and turnaround time for consultation compared with time to see a specialist.
Results: 79 consultations took place. 90% (n=71) of consultations were for services related to oncology. 90% of consultations involved new recommendations for treatment. The most common recommendation was a new chemotherapeutic regimen (68%, n=54). Diagnosis changed in 5% (n=4) of cases. The average turnaround time was 6.8 working days compared with an average of 19 working days to see a comparable specialist.
Conclusions: Internet based consultations between specialists at centres of excellence and referring doctors contribute to patient care through recommendations for new treatment and timely access to specialist knowledge. Although change in diagnosis occurred in only a few cases, the prognostic and therapeutic implications for these patients may be profound.
What is already known on this topic
What is already known on this topic Telemedicine could improve health care by transferring knowledge from centres of excellence to patients' doctors
Few studies have systematically assessed the value of such internet based specialty consultations
What this study adds
What this study adds Patients can benefit from internet based consultations between their doctor and consulting specialists
New recommendations for treatment were discussed in 90% of cases, and change in diagnosis occurred in 5% of cases
Patients can access a specialist's opinion more quickly than waiting to see a specialist
Footnotes
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Funding Partners HealthCare's information system's research and development budget.
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Competing interests All authors are either employed by or have a consulting arrangement with Partners HealthCare. Partners gains revenue from online consultations.
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Details of the website's properties, change in diagnosis, and geographical source of referral appear on bmj.com
- Accepted 20 January 2003