Virtual consultant can improve patient care
22 December 2006
A team led by Professor Owen Epstein (UCL Medicine) has built a service that gives doctors access to specialist knowledge from their desktop, potentially improving and streamlining patient care.
The 'Virtual Consulting Room' consists of four areas designed to help doctors learn about specialist conditions, determine treatment and act within best practice guidelines.
The chief component consists of 370 'patient journeys': clinical flowcharts that doctors can follow down 1,200 'care pathways' according to the symptoms that patients present. The journeys span conditions relevant to Accident & Emergency, general internal medicine, obstetrics & gynaecology, oncology & palliative care, paediatrics, radiology and surgery. The patient journeys are supported by modules covering frequently asked questions; e-helpdesks, through which doctors can email specialists with further queries; and speciality-specific e-referral templates. Information sheets explaining a variety of conditions can also be printed off for patients.
88 per cent of the 58 London-based GPs who trialled the Virtual Consulting Room over eight weeks found it to be "a good learning tool with the potential to alter practice". 82 per cent found it easy to use, even though no training was provided (the interface was deemed to be highly intuitive).
The educational potential of the tool was highlighted in further pilots. In a one-week trial in the Accident & Emergency department of the Royal Free Hampstead NHS Trust, the Virtual Consulting Room improved doctors' and nurses' knowledge in over half of the cases it was consulted. Pre-Registration House Officers who used the Virtual Consulting Room over six weeks found the application improved their knowledge in 94 per cent of cases. It also caused them to alter their decision to refer in over a fifth of cases.
Professor Epstein received a grant from UCL BioMedica to fund the Virtual Consulting Room. Over 250 healthcare professionals from The Royal Free Hampstead NHS Trust and The Royal Free and University College Medical School helped create the content.
Professor Epstein explains the demand for the service: "While there is a vast and increasing array of paper-based clinical guidance emanating from local, national and international sources, in practice, it is unusual to see healthcare professionals consulting these resources. Text-based guidelines are difficult to absorb in Accident & Emergency time frames and lower profile pathways are unavailable for many clinical encounters."
Dr Pasquale Berlingieri adds: "As the pilot was so successful, we hope to generate wider interest within the NHS by demonstrating that a locally developed internet-based application can be easily deployed, interests GPs, is educational and offers the potential to influence patient care."
The NHS has adopted the patient journeys module of the Virtual Consulting Room for the 'Map of Medicine', available online via its 'Connecting for Health' programme.
Papers discussing the use and potential of the application will be published in 2007 in the 'Journal of Telemedicine and Telecare'.
To explore a demonstration version of the Virtual Consulting Room, follow the link at the bottom of this article.