What makes a high-quality electronic consultation (eConsult)? A nominal group study

Christopher S. Tran · Douglas Archibald · Susan M. Humphrey-Murto · Clare E. Liddy

22 citations0/0 files storedJournal of Telemedicine and Telecare

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Healthcare Systems and Technology Electronic Health Records Systems Telemedicine and Telehealth Implementation

Abstract

INTRODUCTION: Poor communication between health professionals can compromise patient safety, yet specialists rarely receive feedback on their written communication. Although worldwide implementation of electronic consultation (eConsult) services is rising rapidly, little is known about the features of effective communication when specialists provide online advice to primary care providers (PCP). To inform efforts to ensure and maintain high-quality communication via eConsult, we aim to identify features of high-quality eConsult advice to incorporate into an assessment tool that can provide specialists with feedback on their correspondence. METHODS: Initial items for the tool were generated by PCPs and specialists using the nominal group technique (NGT). Invited PCPs were above-median eConsult users between July 2016 and June 2017. Specialists were purposively recruited to represent the range of available specialties. Participants individually wrote down items they felt should be included in the tool. A moderator with consensus group expertise then led a round-robin discussion for each item. Items were ranked anonymously and included if highly-ranked by over 70% of participants. RESULTS: Eight PCPs (six family physicians, two nurse practitioners) and three specialists (dermatology, hematology, pediatric orthopedics) produced 49 items that were refined to 14 after group discussion and two rounds of ranking. Highly-ranked items encompassed specific, up-to-date, patient-individualized, and practical advice that the PCP could implement. DISCUSSION: Features of high-quality eConsult correspondence derived from consensus methods highlight similarities and differences between face-to-face consultation letters and eConsult. Our findings could be used to inform feedback and education for eConsult specialists on their advice to PCPs.

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2017The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review 2016Using consensus group methods such as Delphi and Nominal Group in medical education research 2015Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis 2016Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research 2011Referral and Consultation Communication Between Primary Care and Specialist Physicians 2013Utilization, Benefits, and Impact of an e-Consultation Service Across Diverse Specialties and Primary Care Providers 2016Electronic consultation systems: worldwide prevalence and their impact on patient care—a systematic review 2018A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide

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