JMIR Publications

ABSTRACT

Background:

The integration of decision support systems into telemedicine could optimize consultation efficiency and adherence to clinical guidelines; however, the extent of these impacts remains underexplored.

Objective:

This study aimed to evaluate the relationship between the use of International Classification of Disease Study (ICD)-coded prescription decision support systems and the effects of these systems on consultation duration and guideline adherence during telemedicine encounters.

Methods:

In this retrospective, unicentric observational study conducted from October 2021 to March 2022, adult patients who sought urgent virtual care via direct-to-consumer video consultations were included. Physicians had access to current guidelines and could utilize an ICD-triggered prescription decision support system (which was introduced in January 2022 after a preliminary test in the preceding month) for 26 guideline-based conditions. The study compared the use of automated prescription postimplementation with manual prescription data regarding consultation time and guideline adherence.

Results:

This study included 10,485 telemedicine encounters involving 9,644 patients, thus resulting in 12,346 prescriptions by 290 physicians. Prior to the introduction of decision support, 4,497 (36.4%) prescriptions were issued, which increased to 7,849 (63.6%) postimplementation. Following system integration, 5,022 (64%) consultations utilized automated prescriptions. The average consultation time decreased significantly to 9.5 ± 5.5 minutes from 11.2 ± 5.9 minutes after the patient was able to access prescription decision support (p < 0.001). Out of 12,346 prescriptions, 8,683 (70.34%) were aligned with the guidelines. Adherence was significantly greater in the decision support group than in the manual group (4,697 [93.5%] vs. 1,389 [49.1%], p < 0.001).

Conclusions:

Prescription decision support systems were readily adopted by physicians, thus demonstrating the system's utility in reducing consultation times and increasing adherence to guidelines. These systems prove valuable in enhancing the efficiency and quality of telemedicine consultations by supporting evidence-based clinical decision-making.