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Clinicians who treat patients with gynecologic cancers are open to adopting telemedicine consultation if the system can be streamlined to share patient records easily, a study showed.

Many gynecologic cancer patients do not receive guideline-concordant care -- in part due to lack of geographic access to gynecologic oncologists. Telemedical technology allows local physicians to consult with subspecialists without burdening patients with unnecessary in-person visits.

The new study gauged clinicians' acceptance of telemedicine consultation for the management of gynecologic cancers. The researchers recruited clinicians from practices serving rural patient populations to participate in semi-structured interviews to gather feedback about experiences with referrals, communication, and openness to telemedical consultation between gynecologic oncologists, gynecologists, and medical oncologists.

David I. Shalowitz, MD, MSHP, a gynecologic oncologist at West Michigan Cancer Center Radiation & Surgical 乌鸦传媒 in Kalamazoo, where he is Director for Health Equity and Community Outreach, presented the results at the .

He discussed additional information about the study in the following interview.

What does this study add to the literature?

Shalowitz: Most of the literature on telemedicine's ability to reduce the financial toxicity of cancer care involves moving traditional, in-person care to virtual care. However, the potential of remote communication between clinicians to improve cancer care has been understudied, especially for rural populations.

Prior to implementing a formalized program to facilitate telemedical coordination of gynecologic cancer care, we felt it was important to engage with gynecologic oncologists, medical oncologists, and general gynecologists to assess clinicians' needs.

Clinicians overwhelmingly saw the potential of telemedical communication with their colleagues to facilitate referral, establish relationships among clinicians, ensure appropriate testing, and ultimately spare patients the burdens of traveling for in-person visits that may not be necessary. However, they were also very aware of the challenges of integrating formal telemedical consultation between clinicians into their already sometimes overwhelmingly busy workflow.

What was the rationale for the study?

Shalowitz: Clinician-to-clinician telemedical consultation has the potential to dramatically improve the efficiency and quality of cancer care. However, sustainable adoption of virtual consultation platforms requires careful attention to cancer care providers and their work environments. We therefore conducted in-depth interviews with a diverse group of clinicians involved in the triage and care of patients with gynecologic cancers to elicit perspectives on formalizing this use of telemedicine for cancer care.

We conducted 11 interviews (with six gynecologic oncologists, three gynecologists, and two medical oncologists). We identified six themes, which included hesitancy to adopt new methods of communication, frustration with existing methods, and potential gaps that could be filled by a cloud-based asynchronous platform.

The six themes were the following:

• Providers are overwhelmed by existing communication channels, including electronic health records (EHRs), phone, fax, pagers, and text

• Providers are concerned about burnout, increased work volume, interruptions to workflow, and effectiveness of communication

• Providers want more information about accountability and compensation in using a formalized consultation platform

• Some gynecologists feel there is a barrier to reaching out to gynecologic oncologists and medical oncologists when there is not an existing relationship; specialists are frustrated by lack of information sharing or previous testing from referrals

• Providers find it difficult to share patient information with other providers not on the same EHR system

• Providers felt that telemedicine consultation could improve patient access to specialized care

What are the barriers to provider-to-provider telemedicine consultation?

Shalowitz: Clinicians identified concerns about burnout, increased work volume, and interruptions to workflow as important barriers to adoption of formalized, telemedical consultation between clinicians. They also expressed a strong desire to improve compensation for virtual consultative work.

How did participants experience burnout from communication?

Shalowitz: Clinicians are unfortunately victims of the fragmentation of health information technologies, many of which are poorly interoperable, and few of which have been designed with clinicians' ease-of-use as a priority. This study adds to the evidence that inefficient interaction with health IT [information technology] leads to clinician burnout, and harms care coordination for patients.

Why are providers hesitant to adopt a new platform?

Shalowitz: Clinicians nearly uniformly feel overwhelmed by the number of methods by which they are already expected to communicate with others about patient care, including EHR, phone, text, patient portal, and paging systems. There is a quite reasonable concern that adding additional responsibility would be untenable, even if the goal is to improve patient care.

How could EHR systems be streamlined to share patient records more easily?

Shalowitz: First and foremost, EHR systems must be designed to facilitate clinical care, and prioritize usability by clinical personnel. It would also be useful to consider a consolidated communication infrastructure to avoid the burdens of multiple logins and interfaces.

What's the bottom-line message for practicing oncologists?

Shalowitz: Virtual consultation between clinicians has great potential to improve care coordination for cancer patients while simultaneously decreasing the financial toxicity of cancer care. Oncologists should strongly consider formalizing virtual consultation with referring clinicians to improve patients' ability to receive the right cancer care, in the right place, at the right time.

Read the study here.