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"Curbside" or "informal" consultations in the era of Covid and telemedicine

  • 1.  "Curbside" or "informal" consultations in the era of Covid and telemedicine

    Posted 05-01-2020 16:09
    Hi,
    We are discussing how to handle informal or curbside consultations and I was wondering if anyone knows if good systematic research has been done on this topic related to two issues:
    1. Are informal consults any more prone to error than formal ones?
    2. What are the medico-legal ramifications of informal consults - especially with respect to:
    a - putting the consultant at medico-legal risk if the other physician is sued and introduces the consultation in their defense, or quotes the consultant in the chart somewhere without their knowledge?
    b - does the informal (non-documented) nature of the consult put the physician seeking the consultation at a disadvantage in defending an error or suit, since the consultation is not documented and therefore cannot be used as evidence that the physician took any extra steps or care in the case by consulting someone?

    Also if anyone has model documentation practices or policies regarding this they can share, much appreciated.

    I am aware of this paper: Burden M, Sarcone E, et. al. Prospective comparison of curbside versus formal consultations. J Hosp Med. 2013 Jan; 8(1):31-5

    Thank you!
    Luke Perkocha


  • 2.  RE: "Curbside" or "informal" consultations in the era of Covid and telemedicine

    Posted 05-01-2020 18:13

    Hello

    Within KPCO we have been doing eConsults for many years.

    I published on our experience (see reference below) although we did not pursue the medico-legal implications.

    I am copying Libby Sagara. She runs the e-Consult Workgroup. She may have information about the medico-legal issues.

     

    Hi Libby, I am part of an online discussion group called Society to Improve Diagnosis in Medicine.

    One of the member's posted the following (in italics below).   I know that informal consults are not the same as e-Consults but perhaps some of the same principles apply if you have information to help answer Luke's questions.

     

    We are discussing how to handle informal or curbside consultations and I was wondering if anyone knows if good systematic research has been done on this topic related to two issues:

    1. Are informal consults any more prone to error than formal ones?

    2. What are the medico-legal ramifications of informal consults - especially with respect to:

    a - putting the consultant at medico-legal risk if the other physician is sued and introduces the consultation in their defense, or quotes the consultant in the chart somewhere without their knowledge?

    b - does the informal (non-documented) nature of the consult put the physician seeking the consultation at a disadvantage in defending an error or suit, since the consultation is not documented and therefore cannot be used as evidence that the physician took any extra steps or care in the case by consulting someone?

     

    Also if anyone has model documentation practices or policies regarding this they can share, much appreciated.

     

    I am aware of this paper: Burden M, Sarcone E, et. al. Prospective comparison of curbside versus formal consultations. J Hosp Med. 2013 Jan; 8(1):31-5

     

    Thank you!

    Luke Perkocha

     

    Comparing virtual consults to traditional consults using an electronic health record: an observational case–control study

    BMC Med Inform Decis Mak. 2012; 12: 65

    Ted E Palen, David Price, Susan Shetterly, and Kristin B Wallace

     

     

     

    1498684070639_Ted

    Ted E. Palen, PhD, MD, MSPH

    Diplomate American Board of Internal Medicine

    Diplomate Clinical Informatics American Board of Preventive Medicine

    Senior Investigator | Institute for Health Research | Kaiser Permanente Colorado (KPCO)

    Physician Reviewer, KPCO Member Appeals | Colorado Permanente Medical Group

    2550 S Parker Rd, Suite 200 | Aurora, CO 80014 | ( 303-636-2406 | cell 303-514-8126 | 7 303-636-2945

    Email: Ted.E.Palen@kp.org

    Assistant | Yvonne Graves | 7303.636.2907 | Yvonne.X.Graves@kp.org

     

     

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