Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare

Stoves, John; Connolly, John; Cheung, Chee Kay; Grange, Angela; Rhodes, Penny; O’Donoghue, Dónal; Wright, John

doi:10.1136/qshc.2009.038984

Cited by 76 publications

(79 citation statements)

References 11 publications

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“…Studies have reported electronic consulting where nephrologists had full access to the electronic health record of the patient. 12,13 Access issues may raise privacy concerns, however, as more information is available to the nephrologist than is necessary for the consultation.…”

Section: W Eb -Ba Sed Consultat Ions F or Chronic K Idne Y Dise A Sementioning

confidence: 99%

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease

Haan

Gelder

Weel

et al. 2013

The Annals of Family Medicine

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PURPOSE A Web-based consultation system (telenephrology) enables family physicians to consult a nephrologist about a patient with chronic kidney disease. Relevant data are exported from the patient's electronic fi le to a protected digital environment from which advice can be formulated by the nephrologist. The primary purpose of this study was to assess the potential of telenephrology to reduce in-person referrals. METHODSIn an observational, prospective study, we analyzed telenephrology consultations by 28 family practices and 5 nephrology departments in the Netherlands between May 2009 and August 2011. The primary outcome was the potential reduction of in-person referrals, measured as the difference between the number of intended referrals as stated by the family physician and the number of referrals requested by the nephrologist. The secondary outcome was the usability of the system, expressed as time invested, the implementation in daily work hours, and the response time. Furthermore, we evaluated the questions asked. RESULTSOne hundred twenty-two new consultations were included in the study. In the absence of telenephrology, 43 patients (35.3%) would have been referred by their family physicians, whereas the nephrologist considered referral necessary in only 17 patients (13.9%) (P <.001). The family physician would have treated 79 patients in primary care. The nephrologist deemed referral necessary for 10 of these patients. Time investment per consultation amounted to less than 10 minutes. Consultations were mainly performed during offi ce hours. Response time was 1.6 days (95% CI, 1.2-1.9 days). Most questions concerned estimated glomerular fi ltration rate, proteinuria, and blood pressure. CONCLUSION A Web-based consultation system might reduce the number of referrals and is usable. Telenephrology may contribute to an effective use of health facilities by allowing patients to be treated in primary care with remote support by a nephrologist.

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Section: W Eb -Ba Sed Consultat Ions F or Chronic K Idne Y Dise A Sementioning

confidence: 99%

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease

Haan

Gelder

Weel

et al. 2013

The Annals of Family Medicine

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“…eConsult links primary care providers (PCPs)-a group that includes family physicians (MDs) and nurse practitioners (NPs)-and specialists through electronic means and enables specialist advice to be given directly, often without the need for a face-to-face visit. 4,6,7 We developed and deployed an eConsult service in our health region in 2010; this service is known as the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service. The project was launched to address issues with excessive wait times in our region, which, depending on the specialty, exceeded 9 months for nonurgent appointments.…”

mentioning

confidence: 99%

Impact of and Satisfaction with a New eConsult Service: A Mixed Methods Study of Primary Care Providers

Liddy

Afkham

Drosinis

et al. 2015

The Journal of the American Board of Family Medicine

120

131

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Objectives:We have improved access to specialist care and decreased wait times in our region through the development and implementation of the Champlain BASE (Building Access to Specialists through eConsultation) service. This secure, web-based tool allows primary care providers (PCPs) quick access to specialist advice for their patients and often helps to avoid the need for a face-to-face referral. Our successful implementation of eConsult in our region provides a unique opportunity to examine PCPs' satisfaction and overall perspective on using the service.Methods

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“…Researchers in healthcare have attempted to overcome the above barriers through EHR's [15][16][17][18][19]. The rapidly expanding use of EHR's in primary care, incentivized by the recent federal health care reform initiative, has a great potential to connect smokers with evidence-based treatment [20,21].…”

Section: Introductionmentioning

confidence: 99%

Electronic health records as a tool for recruitment of participants' clinical effectiveness research: lessons learned from tobacco cessation

Fraser

Christiansen²,

Adsit³

et al. 2012

Behav. Med. Pract. Policy Res.

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Translating tobacco dependence treatments that are effective in research settings into real-world clinical settings remains challenging. Electronic health record (EHR) technology can facilitate this process. This paper describes the accomplishments and lessons learned from a translational team science (clinic/research) approach to the development of an EHR tool for participant recruitment and clinic engagement in tobacco cessation research. All team stakeholdersresearch, clinical, and IT-were engaged in the design and planning of the project. Results over the first 17 months of the study showed that over one half of all smokers, coming in for any type of clinic appointment, were offered participation in the study, a very high level of adherent use of the EHR. Study recruitment over this period was 1,071 individuals, over 12 % of smokers in the participating clinics. KEYWORDSElectronic health records, Recruitment, Tobacco cessation BACKGROUND While research advances have extended the effectiveness and reach of tobacco dependence treatment over the past two decades, the disjointed process for bringing laboratory advances into clinical practice has often resulted in interventions that yield diminished effects in real world use [1][2][3][4][5]. One approach to address this "translation gap" is to develop and test interventions in real world clinical settings whenever possible. However, research conducted in these settings poses challenges that can compromise internal validity (e.g., reduce the accurate assessment of outcomes) or render the intervention context unrepresentative of real world conditions (e.g., due to burdensome consent processes, confidentiality regulations, and assessment burdens). Despite these limitations, strategies are available that can foster enhanced translation. For instance, in the case of interventions designed for use in healthcare settings, research designs can enhance translation by leveraging existing clinic infrastructure and

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Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare

Cited by 76 publications

References 11 publications

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease

Impact of and Satisfaction with a New eConsult Service: A Mixed Methods Study of Primary Care Providers

Electronic health records as a tool for recruitment of participants' clinical effectiveness research: lessons learned from tobacco cessation

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