Evaluation of the lack of quality of e-consultation as perceived by experienced patients and providers in primary care

Background: Despite its potential, the use of patient-provider e-consultation has not yet been widespread in primary care due to concerns about the quality of care [1]. However, there is little empirical research into the lack of quality of e-consultation. Objective: To determine the lack of quality as perceived by patient and providers with experience in e-consultation. Methods: We carried out in-depth structured interviews with 19 patients and 11 providers (GP and other care providers), who currently use secure e-consultation systems, i.e. secure internet based systems with direct consultation by email and indirect e-consultation by means of triage systems. In-depth interviews with patients and providers were conducted to assess the quality of e-consultation, using as a framework for the discussion the quality criteria as outlined in the Institute of Medicine report [2]. Quality criteria were tailored to specific e-consultation systems and we assessed lack of quality with regard to e-health policy, implementation, usability, quality of interaction between patient and provider, control of care, and control of information. Results: The 19 patients mentioned 125 incidents of lack of quality and the 11 providers mentioned 105 incidents of lack of quality. Mentioned incidents were categorized independently by two observers into the quality categories. Among patients most incidents of lack of quality were related to inadequate implementation (33%), lack of ability to control information (18%), lack of good usability of the system (17%), poor e-health policy (15%) and poor quality of interaction (14%). Lack of control of care was infrequently mentioned by patients (4%). Among care providers most incidents of lack of quality were related to poor implementation (35%), poor usability of the system (28%), poor quality of interaction (15%) and poor control of care (8%). Lack of control of information was infrequently mentioned by providers (1%). Conclusions: It can be concluded that both among patients and providers inadequate implementation causes most incidents of lack of quality. Among patients lack of quality of control of information is frequently mentioned, but not among providers. This problem can be attributed to the use of medical terms and medical thinking in triage systems, which poorly reflect the problem solving strategies of patients. Unexpectedly, it was also found that care providers do have more problems in usability of e-consultation systems than patients. This is caused by incompatibility of e-health systems with available electronic patient record systems