Evaluation of the lack of quality of econsultation

1
Evaluation of the lack of quality of
e-consultation as perceived by experienced
patients and providers in primary care N.
Nijland1, M.Heikamp1, H. Boer2, W. Salzman3,
J.E.W.C. van Gemert-Pijnen1 1Department of
Communication Studies, Faculty of Behavioural
Sciences, University of Twente, Enschede, the
Netherlands 2Department of Psychology, Faculty of
Behavioural Sciences, University of Twente,
Enschede, the Netherlands 3Department of social
health care, Health Care Insurance Board, the
Netherlands
Introduction and purpose Despite its potential,
the use of e-consultation is not yet widespread
in primary care due to concerns about the quality
of care 1. The aim of this study was to
determine a possible perceived lack of quality by
patients and care providers while using several
distinctive e-consultation systems. The systems
offered information ranging from general health
to medical advice from a care provider. Methods
In-depth semi-structured interviews were
conducted with 19 patients and 11 care providers
to identify the experiences patients and
providers when using e-consultation. By means of
practice tests (real-time use) with 14 patients
and 14 care providers, we made a thorough
assessment of the user-friendliness of three
commonly used secure e-consultation systems in
the Netherlands (Praktijkinfo, Medicinfo, and
Dokterdokter). Although the systems were
developed in the Netherlands, they are based on
international standards 2. 1 Brooks RG,
Menachemi N. Physicians Use of Email With
Patients Factors Influencing Electronic
Communication and Adherence to Best Practices. J
Med Internet Res 20068(1)e2. URLhttp//www.jmir
.org/2006/1/e2/ 2 Institute of Medicine.
Crossing the Quality Chasm A New Health System
for the 21st Century. Washington, DC National
Academy Press Jun 1 2001. URLhttp//www.nap.edu/
books/0309072808/html/

• Results
• In-depth interviews
• Experienced lack of quality regarding (see table
  1)
• E-health policy a quality control system fails
  and regulations about e-consultation are
  nontransparent.
• Implementation of the system (high lack of
  quality)
• patients and care providers are not familiar with
  the guidelines of
• e-consultation and many of the functionalities of
  the system.
• Patient-provider interaction patients, and
  especially care providers, are afraid of
  communication errors. Providers are also
  concerned about legal consequences of e-mail
  which leads to cautiously formulated answers.
• Control of care the generated advice for
  self-care doesnt meet the expectations of
  patients. E-consult often provides too little
  information about the health problem of a
  patient, as a result a doctors visit is still
  necessary.
• Feasibility of the system (high lack of
  quality)
• Unclear navigation structure and technical
  problems hinder problem solving by means of
  e-consultation.
• Convenience of e-consultation e-consultation is
  time-consuming due to unfamiliarity with the
  system/service.
• Practice tests
• Experienced lack of quality regarding the process
  of problem solving by means of various aspects of
  e-consultation
• Searching for general health information on the
  website Patients have difficulties with
  searching information on the website due to
  problems with the feasibility of the system and
  not being attuned to solving e-health problems.
  They prefer searching information by means of a
  search engine like google.
• An indirect e-consult (intervention of a triage
  system)
• According to patients the self-care advice
  generated by the triage system is insufficiently
  tailored to their personal needs. The advice is
  not distinctive from information provided by
  brochure and as such not tailored to
  self-management of health problems.

• Conclusion
• The care delivery process by means of
  e-consultation requires a communication structure
  sufficiently authoritative to clearly illustrate
  the indicators on which a modality of a
  technological solution can be chosen.
• An adequate infrastructure fails in educating
  and training end-users. Education of both health
  consumers and care providers on the guidelines
  and the functionalities of the electronic care
  system is necessary to improve e-consultation.
• The knowledge systems for digital triage
  (indirect e-consult) should be tailored to the
  needs and skills of various users to foster self
  care . Further research is necessary to value the
  potential role of e-consult via e-mail or digital
  triage in primary care.

Table 1. Experienced lack of quality of
e-consultation (n30)