Researchers from NYU Langone Medical Center in New York City worked with a vendor to develop a virtual consult system that facilitates instant-message chat sessions and screen-sharing capability between referring physicians and subspecialty radiologists. In a test, they found that 85% of referring physicians judged the system to have affected patient management.
On the downside, radiologists who participated in the test were not as enthusiastic about the system, citing the interruption to their workflow.
"The [virtual consult] addresses a key challenge in the current era of digital radiology practice and provides added value to referrers, though continued radiologists' workflow optimization is warranted," wrote the team led by Dr Andrew Rosenkrantz.
In today's radiology environment, radiologists typically perform their interpretation tasks in other locations from where referring physicians provide patient care. This separation comes with the risk of detaching radiologists from patient clinical teams, weakening their integration with other providers and potentially hurting patient care, according to the researchers.
To facilitate dialogue for reviewing images and reports, the institution's radiology IT division and medical center IT department teamed up with radiology applications developer Primordial to add a virtual consultation capability to the company's existing radiology workflow engine software.
The referring physician can directly launch the virtual consult system via the electronic medical record (EMR) (Epic Systems), while the radiologist can access it through the PACS (iSite, Philips Healthcare). By clicking on a link in the report, the referring physician can send an instant message to the appropriate subspecialist radiologist, who receives the alert and can automatically load the exam for review. In addition to discussing the study over instant messaging, they could also choose to launch real-time screen-sharing software (Cisco WebEx) for the radiologist's PACS display.
After the virtual consult system had been used for 110 sessions, the researchers surveyed both the referring physicians and the radiologists to assess its value. Seventy-four referring physicians and 47 radiologists used the system during the study period.
The most frequent users of the system were emergency medicine physicians (27.3%), followed by internal medicine physicians (13.6%). As for the radiologists, the most common subspecialties requested for consults were abdominal (33.6%) and thoracic (16.4%) imaging, according to the team.
Of the 74 referring physician users, 20 responded to the survey, which queried whether they agreed or disagreed on a scale of 1 to 5 with several statements. A score of 4 or 5 indicated agreement.
Referring physician agreement on survey questions was as follows:
- The virtual consult system was easy to use: 90%
- The virtual consult system affected patient management: 85%
- Access to a subspecialized radiologist was helpful: 85%
- The virtual consult system enhanced integration of radiologists into the care team: 85%
- The virtual consult system improved their understanding of the radiologist report: 80%
- The direct screen shares were helpful (for the 10 respondents who used the screen shares): 70%
Free-text responses added by the referring physicians highlighted the system's perceived utility in situations when it would be challenging to arrange for a traditional consultation, according to the researchers.
"The [virtual consult system] seemed to be of particular value in contexts when time, location, or other circumstances would make a conventional consultation difficult, as well as to be of value as a vehicle for achieving a quick response to a particular question," they wrote.
The researchers noted that there were 17 screen-sharing sessions over the course of the study, with an average duration of 12 minutes (± 16 minutes).
Radiologists acknowledged the value of the virtual consults to the referring physicians, but they tended to express concern about interruptions to their workflow, according to the researchers.
Radiologist agreement on survey questions was as follows:
- The virtual consult system enhanced the integration of the radiologist into the clinical care team: 73.9%
- The virtual consult system was easy to use: 69%
- The virtual consult system was disruptive to normal workflow: 60.9%
- Participation in the virtual consult contributed positively to patient care: 60.9%
Free-text responses by the radiologists reflected some positive feedback from referring physicians, but they also touched on logistical challenges in implementing the system in an optimal fashion as well as its potentially disruptive nature, according to the team.
"Identifying solutions to allow radiologists' participation in the [virtual consult] with minimal sense of workflow disruption will be a critical issue for achieving radiologists' buy-in and the long-term success of the tool," they wrote.
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