TeleMed and eHealth‘06

The Virtual Consulting Room:an intuitive solution to bridge the eternal divide

between primary and secondary care.

P. Berlingieri, E. Wood, T. Rayne, D. Norris, John Linehan, O. Epstein

The Royal Free & University College Medical SchoolUniversity College London

Virtual Consulting Room (VcR)Virtual Consulting Room (VcR)

Internet-based medical application:– allows rapid access to specialist knowledge– provides a platform for incremental consultation

It has been developed by more than 250 healthcare professionals:– The Royal Free Hampstead NHS Trust– The Royal Free and University College Medical School

The VcR homepage

A specialty homepage

Each specialty hosts four consultation layers:

patient journeys

frequently asked questions

e-specialty helpdesk

e-specific referral letters

Patient journeys module

Haematemesis & Melaena pathway

FAQ’s module

Helpdesk component

E-specific referral letter

SAMPLER DEMONSTRATION

http://ucl.ac.uk/medicalschool/current-students/learning-resources/Virtual-consulting-room-demo/http://ucl.ac.uk/medicalschool/current-students/learning-resources/Virtual-consulting-room-demo/. .

BACKGROUNDWhy testing in a primary care setting?

– Since the advent of the National Health Service (NHS), the primary method for General Practitioners (GPs) to obtain a consultant opinion has been referral to a specialist outpatient clinic.

– The disequilibrium between supply and demand has resulted in an intractable bottleneck at the primary-secondary care interface.

– The inability of the NHS to support rapid communication between healthcare professionals is partly responsible for unnecessary delays in patient care

AIMS

To create an internet medical consultation application in order:– to facilitate communication and knowledge

interchange between healthcare professionals– to streamline patient care

To test its initial use in primary care

METHODS

Invitation letters and a demonstration CD were sent to 22 local general practices

Each participating GP:– was given instructions on how download icon

to access the VcR– was invited to use the VcR during the course of

daily practice

No prior training was required

METHODSA software (WebTrends) programme was set up to monitor GP use of the VcR:– number of hits per visit– which GP had visited the VcR– how many times a page was consulted– time of day each consultation was made

A questionnaire was circulated to all GPs– eight categories– five point Likert scale was used to evaluate attitudes towards the VcR– free text comments were welcomed

RESULTS

Engagement of GPs

– 22 local general practices were invited– 13 (59.1%) were interest in accessing the VcR

3 without prior demonstration

10 with a single practical demonstration

58 GPs were identified as potential users

RESULTSPatterns of use of the VcR

– Of the participating 58 GPs (possible users)• 19 (32.8 %) were repeat users (≥ 3 visits)• 15 (25.9 %) used the VcR only once or twice• 19 (32.8 %) were non users by choice• 5 ( 8.6 %) were non users due to unresolved technical problems

– 34/58 GPs consulted the VcR (58.6%) – 27/34 registered within the first 4 weeks (79.4%)– The mean frequency of visits per consulting GP was 5.2

(range 1-35; SD 6.7)

RESULTSFigure 1 illustrates the number of visits each weekThere was a total of 177 consultations over the study period. This gives a mean of 22.1 visits per working week (range 11-29; SD 6.5).In total there were 35,244 hits (mean of 4,405.5 hits per week, range 1,924-7,692; SD 2128.1).On average there were:

– 199.1 hits per GP visit– 881.1 hits per working day.

Total number of GP visits by day of the week

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70

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Number of GP visits per week

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Figure 2 shows the number of GP visits to the VcR by day of the week.The VcR was most frequently visited on Wednesdays.The most popular time of day for consultation was 15:00h.

RESULTS

All department in the VcR were visited

– Gastroenterology (40)– Dermatology (21)– Cardiology (19)– Accident & Emergency (19)

RESULTS

Gastroenterology

– patient journeys (20)– FAQ’s (7)– specialist helpdesk (12), used in 2 occasions– referral templates (11), used in 3 occasions

RESULTS

Questionnaire responses

• 31/58 were received: 23 had accessed the VcR

8 did not access the VcR

23 GPs who accessed the VcR17 described themselves as users

Evaluation of the VcR:• 15 (88.2%) : good educational tool• 14 (82.4%) : easy to use• 13 (76.5%) : accessible

Evaluation of the VcR components (usefulness):• 13 (76.5%) : patient journey• 9 (53.0%) : FAQs module• 7 (41.2%) : patient journey improved patient care• 5 (29.4%) : referral template• 3 (17.6%) : e-helpdesk

8 GPs who did not access the VcR

4 experienced technical problems accessing the site

2 did not have time or need to use the VcR

1 was not computer literate

1 was on leave during the study period

DISCUSSIONIn order to engage even the most reluctant doctor the user interface– visually attractive– intuitive to the point where almost all NHS healthcare

professionals could enter and use the VcR without the need for training.

This is reflected by the observation that:– only 5/58 (8.6%) of GPs indicated that IT issues prevented their

use of the VcR.– Over half the GPs visited the VcR and 19/58 (32.8%)

demonstrated repeated use.

DISCUSSIONOf particular interest is the observation that 7/17 (41.2%) of respondent users indicated that the pathways had improved patient care.

Each GP visit to the VcR was associated with a mean of 200 hits, indicating considerable exploration.

The utility of the referral templates and e-helpdesk were low (29.4% and 17.6% respectively).– This might reflect lack of need for GPs to utilise these functions

over the eight weeks and the limited availability of these modules to only one of the 13 medical specialities (Gastroenterology).

CONCLUSIONSLike the sequential phases of drug development, an incremental approach is recommended for successful implementation of complex interventions in healthcare

This study indicates that a locally developed internet-based application:

• can be easily deployed• interests GPs• is educational• offers the potential to influence patient care