Abstract
Backgrounde-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care.ObjectiveThis study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs.MethodsWe conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system.ResultsBoth general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced.ConclusionsThrough an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.
Highlights
Background general pediatricians manage a variety of adolescent health concerns, referrals to adolescent medicine specialists are common
General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for adolescent and young adult electronic health record (EHR) (AYA), primarily by improving efficiency and reducing the potential for errors
Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability https://humanfactors.jmir.org/2021/3/e25568
Summary
General pediatricians manage a variety of adolescent health concerns, referrals to adolescent medicine specialists are common. The scarcity of board-certified adolescent medicine specialists is itself a critical barrier to the care of AYAs. The number of adolescent medicine specialists per state ranges from 3.4 adolescent medicine specialists per 100,000 children in Rhode Island to 0 adolescent medicine specialists in 4 states and Puerto Rico [2]. The number of adolescent medicine specialists per state ranges from 3.4 adolescent medicine specialists per 100,000 children in Rhode Island to 0 adolescent medicine specialists in 4 states and Puerto Rico [2] Owing to this lack of adolescent medicine specialists, travel distance is substantial, and appointment availability does not meet demand [3]. Even with the rapidly increasing use of live-interactive telemedicine for adolescent medicine specialty care in the context of the COVID-19 pandemic [8], both patient-side barriers (eg, low health literacy and limited internet access) and system-side barriers (eg, inadequate supply of adolescent medicine specialists to meet referral demand) remain [9]
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