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. 2020 Jul;26(6):341-348.
doi: 10.1177/1357633X19828130. Epub 2019 Feb 25.

Cardiology electronic consultations: Efficient and safe, but consultant satisfaction is equivocal

Brenton S Bauer  1   2 , Ai Len Nguyen-Phan  1   2   3 , Michael K Ong  2   4 , Boback Ziaeian  1   2 , Kim-Lien Nguyen  1   2
Affiliations

Cardiology electronic consultations: Efficient and safe, but consultant satisfaction is equivocal

Brenton S Bauer et al. J Telemed Telecare. 2020 Jul.

Abstract

Background: Cardiovascular electronic consultation is a new service line in consultative medicine and enables care without in-person office visits. We aimed to evaluate accessibility and time saved as measures of efficiency, determine the safety of cardiology electronic consultations, and assess satisfaction by responding cardiologists.

Methods: Using a mixed-methods approach and a modified time-driven, activity-based, costing framework, we retrospectively analysed cardiology electronic consultations. A random subset of 500 electronic consultations referred between 2013-2017 were reviewed. Accessibility was determined based upon increased number of patients served without the need for an in-person clinic visit. To assess safety, medical records were reviewed for emergency room visits or hospital admission at six months from the initial electronic consultation date. Responding cardiologist satisfaction was assessed by voluntary completion of an online survey.

Results: The majority of electronic consultations were related to medication advice, clearance for surgery, evaluation of images, or guidance after abnormal testing. Recommendations included echo (10.8%), stress testing (5.0%), other imaging (4.0%) and other subspecialist referrals (3.8%). Electronic consultations were completed within 0.7±0.5 days of the request, with a time to completion of 5-30 min. Over a six-month follow-up, 13.9% of patients had an in-person visit and 2.2% of patients were hospitalised, but none were directly related to the electronic consultation question. Satisfaction by responding cardiologists was modest.

Conclusion: In conclusion, within a single-payer system, cardiology electronic consultations represent a convenient and safe alternative for providing consultative cardiovascular care, but further optimization is necessary to minimise electronic consultation fatigue experienced by cardiologists.

Keywords: Electronic consultation; cardiology; specialty care; veterans.

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Conflict of interest statement

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Comparison of workflow between telecardiology e-consultation (left) and conventional in-person clinic referral (right) in the cardiovascular care delivery value chain (CDVC). CDVC is a framework that conceptualises the organization and structure of care delivery for various medical conditions. In some cases, conventional in-person cardiology consultations are converted to e-consults and vice-versa. E-consultation mitigates third-party ancillary processes (*), which streamlines the communication between users (primary care team) and cardiology consultants. MD: medical doctor.
Figure 2.
Figure 2.
Number of cardiology e-consultations between 2013–2017 and users of cardiology e-consultations. Bar graphs display (a) the total number of cardiology e-consultations between 2013 and 2017 and (b) user frequency of cardiology e-consultations. Non-clinical staff consisted of clinical specialists, social workers, clinic/centre clerks and other personnel from preventive medicine. DO: doctor of osteopathic medicine; MD: medical doctor; RN: registered nurse.
Figure 3.
Figure 3.
Survey responses from cardiology consultants (n=6).
See this image and copyright information in PMC

References

    1. Gatley S, Grace A and Lopes V. E-referral and e-triage as mechanisms for enhancing and monitoring patient care across the primary-secondary provider interface. J Telemed Telecare 2003; 9: 350–352. - PubMed
    1. Chen AH, Murphy EJ and Yee HF Jr. eReferral–a new model for integrated care. N Engl J Med 2013; 368: 2450–2453. - PubMed
    1. Wittson CL and Benschoter R. Two-way television: Helping the medical center reach out. Am J Psychiatry 1972; 129: 624–627. - PubMed
    1. Godleski L, Nieves JE, Darkins A, et al. VA telemental health: Suicide assessment. Behav Sci Law 2008; 26: 271–286. - PubMed
    1. Hill RD, Luptak MK, Rupper RW, et al. Review of Veterans Health Administration telemedicine interventions. Am J Manag Care 2010; 16: e302–e310. - PubMed