JMIR Publications

ABSTRACT

Background:

Electronic consultations between primary care physicians and specialists are a valuable means to improve access to specialty care. Adolescents and young adults face unique challenges in accessing limited adolescent medicine specialty care resources, contributing to delayed or forgone care. Electronic consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care, but optimal application of this model within adolescent medicine requires careful attention to nuances of adolescent and young adult care.

Objective:

This study aimed to qualitatively analyze feedback obtained during iterative development of an electronic consultation system for communication between general pediatricians and adolescent medicine specialists that is tailored to the specific healthcare needs of adolescents and young adults.

Methods:

We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static electronic consultation prototype and storyboards, and evaluated it 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 completed “think-aloud” feedback during use of the prototypes and semi-structured exit interviews which were qualitatively analyzed to identify perspectives related to the usefulness and usability of the electronic consultation system.

Results:

Both general pediatricians (N=12) and adolescent medicine specialists (N=12) perceived usefulness of electronic consultations for adolescent and young adult patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize usability of electronic consultations for adolescents and young adults primarily by improving efficiency (e.g., reducing documentation, emphasizing critical information, using auto-populated data fields, and balancing specificity and efficiency through text prompts) and reducing potential for errors (e.g., prompting review of auto-populated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, while documentation of communication and confidentiality expectations was enhanced.

Conclusions:

Through an iterative user-centered design process, we identified user perspectives to guide refinement of an electronic consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to care of adolescents and young adults. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts which should be considered in the development and use of electronic consultations with adolescents and young adults. Clinical Trial: N/A