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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Medical Informatics and Decision Making 1/2012

Comparing virtual consults to traditional consults using an electronic health record: an observational case–control study

BMC Medical Informatics and Decision Making > Ausgabe 1/2012
Ted E Palen, David Price, Susan Shetterly, Kristin B Wallace
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6947-12-65) contains supplementary material, which is available to authorized users.
Ted E Palen, David Price, Susan Shetterly contributed equally to this work.

Competing interests

TEP and DP are employees of the Colorado Permanente Medical Group. SS and KBW are employees of Kaiser Health Plan Colorado.

Authors' contributions

TEP carried out the design of the study, assisted in the analysis, and drafted the manuscript. DP participated in the design, assisted in the analysis, and assisted in drafting the manuscript. SS performed all statistical analyses and participated with editing the manuscript. KBW performed the patient and physician surveys and collected data along with editing the manuscript. All authors read and approved the final manuscript.



Patients have typically received health care through face-to-face encounters. However, expansion of electronic communication and electronic health records (EHRs) provide alternative means for patient and physicians to interact. Electronic consultations may complement regular healthcare by providing “better, faster, cheaper” processes for diagnosing, treating, and monitoring health conditions. Virtual consultation between physicians may provide a method of streamlining care, potentially saving patients the time and expense of added visits. The purpose of this study was to compare physician usage and patient satisfaction with virtual consultations (VCs) with traditional consultations (TCs) facilitated within an EHR.


We conducted an observational case–control survey study within Kaiser Permanente, Colorado. A sample of patients who had VCs requested by physicians (N = 270) were matched with patients who had TCs requested by physicians (N = 270), by patient age, gender, reason for the consult, and specialty department. These patients (VC and TC), were invited to participate in a satisfaction survey. In addition, 205 primary care physicians who submitted a VC or TC were surveyed.


During the study period, 58,146 VC or TC were requested (TC = 96.3%). Patients who completed a satisfaction survey (267 out of 540 patients, 49.4% response rate) indicated they were satisfied with their care, irrespective of the kind of consult (mean 10-point Likert score of 8.5). 88 of 205 primary care physicians surveyed (42.9%) returned at least one survey; VC and TC survey response rates and consulted departments were comparable (p = 0.13). More TCs than VCs requested transfer of patient care (p = 0.03), assistance with diagnosis (p = 0.04) or initiating treatment (p =0.04). Within 3 weeks of the consultation request, 72.1% of respondents reported receiving information from VCs, compared with 33.9% of the TCs (p < 0.001). Utility of information provided by consultants and satisfaction with consultations did not differ between VCs and TCs.


Referring physicians received information from consultants more quickly from VCs compared with TCs, but the value and application of information from both types of consultations were similar. VCs may decrease the need for face-to-face specialty encounters without a decrease in the patient’s perception of care.
Additional file 1:Telephone script for introduction and verbal consent for virtual consults patient satisfaction survey.(DOC 30 KB)
Additional file 2:Patient satisfaction survey.(DOC 28 KB)
Additional file 3:Referring physician Survey.(DOC 28 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
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