Digital Health Platforms May Not be a Cure All Solution

Online consultations may reduce the need for in-person appointments, but challenges can still arise.

Online consultations with general practitioners (GPs) have been touted as something that could revolutionize the health care industry; however, a new report published by BMJ Open suggests that online consults may not reduce GP workload and wait times as hoped.

The study authors evaluated eConsult, which is an online consultation platform in which patients can submit their symptoms for review by their physician electronically. This system was implemented in 36 practices in England.

"While our study focused on a particular system in a regional GP consortium, there are lessons here for any GP practice considering moving to an electronic consultation system. There is a central government drive to move to these systems. However, our research shows that they need to be carefully implemented and effectively marketed to yield the benefits that politicians are hoping for,” said researcher Jeremy Horwood, PhD. "Online consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex."

The authors assessed usage, how patients used other care services, patient surveys, and also interviewed staff about the platform.

Overall, the researchers discovered that the use of the platform was scarce, with only 2 e-consultations occurring per month for every 1000 patients, according to the study.

Notably, usage was the lowest outside of standard GP hours, with the most significant dip in usage occurring over the weekend. Nearly 60% of e-consultations occurred Monday to Wednesday and 12% over the weekend, according to the study.

Patients using the e-consultation services were more likely to be female and aged 25 to 44 years.

The authors found that patients commonly used the platform for physicians’ notes or prescription refills, infections, and pain-related symptoms.

When interviewed, a majority of patients said they valued the platform and clinicians said it worked best for simple issues that did not require face-to-face or telephone follow-up, according to the study.

Physicians said the platform is beneficial because it improves health care access and reduces the need for face-to-face appointments, allowing them to focus on other valuable tasks with their time; however, the physicians also said that there are significant challenges that exist.

Approximately 38% of e-consultations ended in an in-office visit, most of which involved patients presenting with a new condition, according to the study. Another 32% required a phone call to make a clinical decision.

The staff said that cases that ended in a face-to-face interaction took more time than it would have if there was a standard appointment at the beginning.

Although the authors found that e-consultations did not provide immediate savings, the investigators said it may improve access to health care.

Overall, e-consultations have potential but may be limited by the platform itself and the way practices implement the services, according to the study.

"Online consultations may not be a silver bullet, although our experience shows they could be a significant part of the solution, and have evolved a long way since this study was carried out,” said Murray Ellender, chief executive, eConsult. “It is encouraging to note from the evaluation that more than 6 in 10 online consultations did not require a face-to-face consultation, and quantifiable feedback from patients indicates they value having this option."