Information in practice

Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review

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, director. 

Partners Telemedicine, 2 Longfellow Place, Suite 216, Boston, MA 02114, USA

Correspondence to: J C Kvedar jkvedar{at}partners.org

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 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 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