Evaluation of the lack of quality of e-consultation as perceived by experienced patients and providers in primary care N. Nijland 1, M.Heikamp 1, H. Boer 2, W. Salzman 3, J.E.W.C. van Gemert-Pijnen 1 1 Department of Communication Studies, Faculty of Behavioural Sciences, University of Twente, Enschede, the Netherlands 2 Department of Psychology, Faculty of Behavioural Sciences, University of Twente, Enschede, the Netherlands 3 Department of social health care, Health Care Insurance Board, the Netherlands Introduction and purpose Despite its potential, the use of e-consultation is not yet widespread in primary care due to concerns about the quality of care [1]. The aim of this study was to determine a possible perceived lack of quality by patients and care providers while using several distinctive e-consultation systems. The systems offered information ranging from general health to medical advice from a care provider.Methods In-depth semi-structured interviews were conducted with 19 patients and 11 care providers to identify the experiences patients and providers when using e-consultation. By means of practice tests (real-time use) with 14 patients and 14 care providers, we made a thorough assessment of the user-friendliness of three commonly used secure e-consultation systems in the Netherlands (Praktijkinfo, Medicinfo, and Dokterdokter). Although the systems were developed in the Netherlands, they are based on international standards [2]. [1] Brooks RG, Menachemi N. Physicians’ Use of With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices. J Med Internet Res 2006;8(1):e2. URL: [2] Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; Jun URL: In-depth interviews Experienced lack of quality regarding (see table 1): E-health policy: a quality control system fails and regulations about e-consultation are nontransparent. Implementation of the system (high lack of quality): patients and care providers are not familiar with the guidelines of e-consultation and many of the functionalities of the system. Patient-provider interaction: patients, and especially care providers, are afraid of communication errors. Providers are also concerned about legal consequences of which leads to cautiously formulated answers. Control of care: the generated advice for self-care doesn’t meet the expectations of patients. E-consult often provides too little information about the health problem of a patient, as a result a doctor’s visit is still necessary. Feasibility of the system (high lack of quality): Unclear navigation structure and technical problems hinder problem solving by means of e-consultation. Convenience of e-consultation: e-consultation is time- consuming due to unfamiliarity with the system/service. Practice tests Experienced lack of quality regarding the process of problem solving by means of various aspects of e-consultation: Searching for general health information on the website: Patients have difficulties with searching information on the website due to problems with the feasibility of the system and not being attuned to solving e-health problems. They prefer searching information by means of a search engine like ‘google’. An indirect e-consult (intervention of a triage system): According to patients the self-care advice generated by the triage system is insufficiently tailored to their personal needs. The advice is not distinctive from information provided by brochure and as such not tailored to self-management of health problems. A direct e-consult (free-text): Patients are not always satisfied with the answer of the care provider. Providers are unaware of the interpretation of their answer to patients. Therefore a feedback option is desired. Providers experienced lack of quality caused by incompatibility of the e-consultation systems with the available electronic patient record systems. Table 1. Experienced lack of quality of e-consultation (n=30) There’s lack of: Incidents according to care providers (n=99) Incidents according to patients (n=100) E-health policy17,2%21% Implementation27,3%24% Interaction13%21% Control of care6,1%15% Feasibility28,3%17% Convenience8,1%2% Total100% Conclusion The care delivery process by means of e-consultation requires a communication structure sufficiently authoritative to clearly illustrate the indicators on which a modality of a technological solution can be chosen. An adequate infrastructure fails in educating and training end- users. Education of both health consumers and care providers on the guidelines and the functionalities of the electronic care system is necessary to improve e-consultation. The knowledge systems for digital triage (indirect e-consult) should be tailored to the needs and skills of various users to foster self care. Further research is necessary to value the potential role of e-consult via or digital triage in primary care.