eConsultation is a digital service centre that offers solutions not only for remote care but also for health care enterprise resource planning and reporting. The eConsultation service also enables remote assessment of the need for care, remote treatment and appointment operations, as well as consultation between professionals, also between different organisations. [1]
eConsultation provides clients with a website and a mobile app. The service allows the client to contact a professional through the chat service without the need for identification. The client can see the average queuing time and the number of other clients ahead of them in the queue. The client may be invited to attend a remote appointment or a video call either according to a previously set up schedule or by email or by text message. [1]
The professional’s interface provides a chat functionality to invite other professionals to chat and share attachments with the client. The alternative is a video call between the professional and the client. [1]
Research evidence related to the assessed product
As far as consultation between professionals is concerned, there is no researched data on the effectiveness of the service.
The following effects are based on information provided by the company:
A decrease in the number of referrals has been reported in the HUS psychiatric sector, coinciding with the introduction of eConsultation. Similarly, the instructions given in connection with the service for routing and formulating a referral, as well as eConsultation’s role as referral recipient, appear to promote a more streamlined process. According to the company, benefits have been realised in consultations between different specialised health care organizations as the need for patients to travel has diminished. [1]
eConsultation collects information from the patient in advance, which allows a professional to focus on the specifics of the client’s situation. This may speed up and improve the treatment process. [1] There is no scientific evidence of the impact of the collection of advance data.
Client feedback collected by the service provider on the chat service and its usefulness has been mainly positive. In addition, feedback is solicited from the occupational health video appointments, the mental health and substance abuse services appointments, and from the centralised primary health care service, and the experiences in these too are mainly positive. [1]
The eConsultation chatbot, based on artificial intelligence, acts as a first response to an unidentified customer arriving to the service website. The chatbot has been in use at Päijät-Sote and Ylä-Savon Sote since October 2021, and its use has since been extended to the North Savo Wellbeing Services County as well as the private sector. The chatbot does not make decisions on the client’s need for care, but guides clients through the service pathway through search terms defined by professionals. Comprehensive statistical data on the performance and use of the chatbot have been collected during the operational period. The reduced use of the live chat concurrent with the introduction of the chatbot may indicate that chatbot has been accepted as an alternative to a traditional live chat. [1]
Literature reviews
Several studies on telehealth have been published in recent years and, especially during the COVID-19 pandemic, teleconsultation has become a key issue [2]. A review carried out in 2021 demonstrates that remote care can reduce the need for hospital services, in particular with regard to the number of days spent in the hospital [3]. Telemedicine is usually implemented through videoconferencing and telephone connections. Videoconferencing offers several advantages over telephony, including fewer medication errors, greater diagnostic accuracy, and improved decision-making accuracy [4].
Remote assessment of the need for care
A systematic literature review conducted in 2019 assessed the effects of the remote assessment of the need for care on health care. According to the review, remote assessment of the need for care can improve access to health care, reduce emergency and urgent care visits, and provide primary health care advice. However, there remain unresolved issues, such as the long-term impact of such assessments of the need for care and the necessary training for personnel. Although the results are promising, further research is necessary to gain a better understanding of the long-term effects of the remote assessment of the need for care as well as patient satisfaction. [5]
Efficiency and suitability of remote contacts
Although telemedicine can offer an effective alternative to traditional face-to-face consultations for many patient groups, it is important to note that its effectiveness may vary with different circumstances, patient groups, and medical fields [2,6]. In diabetic patients, remote treatment appears to improve blood sugar management and reduce LDL cholesterol. However, no significant differences have been observed between video conferencing and face-to-face treatment with regard to mental health and substance abuse problems. In patients with heart failure, remote treatment improves quality of life, but does not impact mortality compared to traditional treatment. [6]
A study conducted in Finland demonstrates that the remote treatment model for neurological care can improve access to treatment and reduce waiting times, and both patients and doctors are satisfied with the service [7]. The Current Care Guidelines editors have issued a Good Practice consensus recommendation stating that remote consultations and contacts can be made use of in matters related to the patient’s health that do not require a clinical examination at an in-person appointment. Remote contact may also be suitable for monitoring long-term illnesses, providing lifestyle guidance, assessment of the need for acute care, as well as mental health services. [8]
Mobile technologies in communication between health care professionals and care management
Available data on the impact of mobile technologies on the communication between health care professionals as well as care management has been extensively discussed. A 2020 Cochrane review examined the role of mobile technologies in the health care field. The review found that mobile technologies can significantly speed up the initiation of a patient’s treatment, especially when primary care providers and paramedics consult with specialists. At the same time, they provide increased opportunities for clinical trials and reduce referrals to specialised medical care, e.g. in fields such as skin diseases and chronic kidney diseases. Some health care providers expressed uncertainty about the remote treatment of dermatological illnesses as compared to face-to-face treatment. This uncertainty focused in particular on diagnostics and the drafting of treatment plans. However, it is likely that accumulated experience will reduce uncertainty. [9]
Artificial intelligence-based chat programs
The growing need for health care services and the possibilities of artificial intelligence have motivated the development of artificial intelligence-based chat programs, such as chatbots, to support health care provision. Studies have demonstrated the general effectiveness of chatbots in health care, but robust evidence is not yet available in adequate amounts and further studies are needed. [10]
