title: Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review.
abstract: OBJECTIVE
  To assess whether transferring knowledge from specialists at centres of excellence to referring doctors through online consultations can improve the management of patients requiring specialised care.
  
  
  METHODS
  Retrospective case review of the first year of internet based patient initiated consultations between referring doctors and consulting specialists.
  
  
  METHODS
  US teaching hospitals affiliated with an organisation providing internet based consultations.
  
  
  METHODS
  Doctors in various settings around the world engaging in internet based consultations with specialists.
  
  
  METHODS
  New recommendations for treatment, change in diagnosis, and turnaround time for consultation compared with time to see a specialist.
  
  
  RESULTS
  79 consultations took place. 90% (n=71) of consultations were for services related to oncology. 90% of consultations involved new recommendations for treatment. The most common recommendation was a new chemotherapeutic regimen (68%, n=54). Diagnosis changed in 5% (n=4) of cases. The average turnaround time was 6.8 working days compared with an average of 19 working days to see a comparable specialist.
  
  
  CONCLUSIONS
  Internet based consultations between specialists at centres of excellence and referring doctors contribute to patient care through recommendations for new treatment and timely access to specialist knowledge. Although change in diagnosis occurred in only a few cases, the prognostic and therapeutic implications for these patients may be profound.
authors.affiliation: Partners Telemedicine, 2 Longfellow Place, Suite 216, Boston, MA 02114, USA. jkvedar@partners.org
authors.forename: Iris
authors.initials: I
authors.lastname: Kedar
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Ternullo
authors.forename: Carol E
authors.initials: CE
authors.lastname: Weinrib
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Kelleher
authors.forename: Heather
authors.initials: H
authors.lastname: Brandling-Bennett
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kvedar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D020407:Internet; D007400:Interprofessional Relations; D008297:Male; D008490:Medical Informatics / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States