Sezgin Emre, Huang Yungui, Lin Deborah, Ramtekkar Ujjwal, Pauline Lindsey, Lin Simon
Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio, USA.
Telemed J E Health. 2021 Oct;27(10):1143-1150. doi: 10.1089/tmj.2020.0454. Epub 2020 Dec 28.
Background and Objective:The COVID-19 pandemic increased the use of telehealth around the world. The aim is to minimize health care service disruption as well as reducing COVID-19 exposure. However, one of the major operational concerns is cancellations and rescheduling (C/Rs). C/Rs may create additional burden and cost to the patient, provider, and the health system. Our aim is to understand the reasons for C/Rs of the telehealth session after the scheduled start time.
Materials and Methods:We reviewed electronic health records (EHRs) to identify the C/R reasons for behavioral health and speech language pathology departments. Documented C/Rs in the medical charts were identified from EHR by using a keyword-based and Natural Language Processing (NLP)-supported EHR search engine. From the search results, we randomly selected 200 notes and conducted a thematic analysis.
Results:We identified four themes explaining C/R reasons. Most frequent theme was "technicality" (47, 36%), followed by "engagement" (34, 25%), "scheduling" (31, 24%), and "unspecified" (20, 15%). The findings showed that technical reasons are the leading cause of C/Rs, constituting 36% of the cases (95% confidence interval [CI]: 29-43%). Notably, "engagement" constituted a sizeable 25% (95% CI: 19-31%) of C/Rs, as a result of the inability to engage a patient to complete the telehealth session.
Conclusions:The study shows that engagement is one of the new challenges to the pediatric telehealth visits. Future studies of new engagement models are needed for the success of telehealth. Our findings will help fill the literature gaps and may help with enhancing the digital experience for both caregivers and providers, reducing wasted time and resources due to preventable C/Rs, improving clinical operation efficiency, and treatment adherence.
新冠疫情促使全球范围内远程医疗的使用增加。其目的是尽量减少医疗服务中断，并降低感染新冠病毒的风险。然而，主要的运营问题之一是取消和重新安排（C/Rs）。C/Rs可能给患者、医疗服务提供者和医疗系统带来额外负担和成本。我们的目的是了解远程医疗会话在预定开始时间之后取消和重新安排的原因。
我们查阅电子健康记录（EHRs）以确定行为健康和言语语言病理学部门的C/Rs原因。通过使用基于关键词且由自然语言处理（NLP）支持的EHR搜索引擎，从EHR中识别病历中记录的C/Rs。从搜索结果中，我们随机选择200条记录并进行了主题分析。
我们确定了四个解释C/Rs原因的主题。最常见的主题是“技术问题”（47条，占36%），其次是“参与度”（34条，占25%）、“日程安排”（31条，占24%）和“未明确说明”（20条，占15%）。研究结果表明，技术原因是C/Rs的主要原因，占病例的36%（95%置信区间[CI]：29 - 43%）。值得注意的是，由于无法让患者参与完成远程医疗会话，“参与度”占C/Rs的比例相当大，为25%（95% CI：19 - 31%）。
该研究表明，参与度是儿科远程医疗就诊面临的新挑战之一。为了远程医疗的成功，需要对新的参与模式进行未来研究。我们的研究结果将有助于填补文献空白，并可能有助于提升护理人员和医疗服务提供者的数字体验，减少因可预防的C/Rs造成的时间和资源浪费，提高临床运营效率以及治疗依从性。
