Internet Consultations Contribute to Patient Care

Internet consultations between consultants at centres of excellence and referring doctors can contribute to patient care by generating suggestions for new treatments and providing timely access to specialist knowledge, a US study suggests.

The researchers at Partners Telemedicine in Boston, writing in the British Medical Journal, evaluated a service called Partners Online Specialty Consultations that provides specialist opinions on cases and assessments of radiological and pathological results.

The patient initiates the service via the website http://www.econsults.partners.org which generates a letter for his or her physician. The referring doctor then sends relevant notes, images and pathological results to the specialist consultation service. When the consultation is complete, the referring doctor is informed that the results are available on the website. Further discussion of the case can be carried out by telephone.

The 79 referrals evaluated were mostly for cancer patients and new recommendations for treatment were made in 90% of cases. The reviews resulted in a recommendation for a new chemotherapy regime in 68% of cases and the diagnosis was changed for 5% of patients. Just over half the referrals studied came from North America.

Access to the specialists’ opinions was faster using the website taking an average of 6.8 working days compared to 19 working days for a conventional consultation.

The researchers found that the take up of the service was small in comparison to the number of visits to the website and say that the cost of the service – reimbursement for telemedicine is minimal – may have been one of the inhibiting factors.

They say the receptiveness of physicians to online consultation is another challenge but this seems to be growing as electronic records and imaging increasingly become part of routine care.