Research has shown that many patients seek greater accessibility to healthcare, but this can be especially challenging for the surgical community. Studies have suggested that surgeons are facing increasing time constraints due to workforce shortages and higher performance demands. To date, few strategies that have been tested in which clinicians have incorporated new care delivery modalities into general surgical care.
It has been suggested that online postoperative care may improve patient access while increasing surgeon efficiency, but few studies have explored this association. “Use of online patient portals may enhance postoperative care by improving efficiency and patient satisfaction,” says Kristy Kummerow Broman, MD, MPH, “but studies are lacking on whether or not patients would want to use these portals.”
For a study published in the Journal of the American College of Surgeons, Dr. Kummerow Broman and colleagues evaluated patient and surgeon acceptance of online postoperative care after elective general surgical operations. The prospective pilot study involved 50 patients and compared online and in-person postoperative visits. Study enrollment and activities were completed over a 6 month period. Patients in the analysis underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair, which was carried out by one of five surgeons.
“We wanted to determine if all aspects of perioperative care needed to take place in person,” explains Dr. Kummerow Broman. “We thought there might be a role for moving some postoperative care for certain operations to an online environment.” She adds that having patients generate images for patient-to-provider consultation is a relatively new concept.
The portal used for the study had been previously established at Vanderbilt University Medical Center as a way for patients to access health data and communicate with their healthcare providers. As a prerequisite, all study patients were required to have internet access and needed to be able to take and upload digital images to the online portal.
Study participants submitted symptom surveys and wound pictures after their surgeries to the online portal using a smartphone, tablet, or digital camera and computer. They then then corresponded with their surgeons about their symptom reports and wound images using the portal. “Surgeons and patients did not need to be online at the same time,” says Dr. Kummerow Broman. “Instead, they could upload and access information at their own convenience.”
According to the study results, online visits were deemed acceptable to 76% of patients as their only course of follow-up. For 68% of patients, surgeons reported that both online and in-person visits were equally effective. Overall, surgeons reported that clinic visits were more effective in 24% of cases while 8% reported that online visits were more effective. Importantly, the authors noted that no complications were missed via online visits. “Online visits took significantly less time for patients and surgeons,” adds Dr. Kummerow Broman (Table below).
The majority of patients who underwent routine, uncomplicated operations preferred online postoperative consultations to in-person visits, according to the analysis. In addition, surgeons saw benefits for this type of follow-up approach. By the end of the study, all of our participating surgeons saw utility in the concept of online care.
Despite optimism from patients and surgeons, Dr. Kummerow Broman and colleagues acknowledged certain limitations to the study. The data revealed potential advantages of online postoperative care, including convenient access for patients, decreased patient travel times, and surgeon efficiency gains. However, these benefits must be carefully weighed against possible detriments of using patient-generated data to provide clinical assessments. This includes concerns about liability, provider work burden, and modified patient-provider relationships.
“In some surgical cases, an in-person assessment will be required,” says Dr. Kummerow Broman. “The key is to design tools for online care and develop appropriate standards for online assessments so that healthcare providers can determine when it is appropriate to use online care and when in-person care may be needed.” She notes that online portals are a new concept, and patients historically have not been relied upon to generate their own data in the form of digital images.
More studies are needed to establish the safety and potential benefit of online postoperative visits in specific populations. The study by Dr. Kummerow Broman and colleagues was designed to measure patient acceptance rather than safety or quality of care. “We wanted to first establish whether this method was an approach that patients wanted and that surgeons were comfortable with,” Dr. Kummerow Bromansays. “The next step is to continue our research in this area and try to develop ways to measure safety and quality.”
Kristy Kummerow Broman, MD, MPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.
Broman KK, Oyefule OO, Phillips SE, et al. Postoperative care using a secure online patient portal: changing the (inter)face of general surgery. J Am Coll Surg. 2015 Sep 22 [Epub ahead of print]. Available at: http://www.journalacs.org/article/S1072-7515(15)01500-8/fulltext.
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Goldzweig CL, Orshansky G, Paige NM, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med. 2013;159:677–687.
Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Affairs. 2013;32:1361–1367.
McVay MR, Kelley KR, Mathews DL, et al. Postoperative follow-up: is a phone call enough? J Pediatr Surg. 2008;43:83–86.