@Article{info:doi/10.2196/56681,
author="Accorsi, Tarso Augusto Duenhas
and Eduardo, Anderson Aires
and Baptista, Carlos Guilherme
and Moreira, Flavio Tocci
and Morbeck, Renata Albaladejo
and K{\"o}hler, Karen Francine
and Lima, Karine de Amicis
and Pedrotti, Carlos Henrique Sartorato",
title="The Impact of International Classification of Disease--Triggered Prescription Support on Telemedicine: Observational Analysis of Efficiency and Guideline Adherence",
journal="JMIR Med Inform",
year="2024",
month="Oct",
day="25",
volume="12",
pages="e56681",
keywords="telemedicine; clinical decision support systems; electronic prescriptions; guideline adherence; consultation efficiency; International Classification of Disease--coded prescriptions; teleheath; eHealth",
abstract="Background: Integrating decision support systems into telemedicine may optimize consultation efficiency and adherence to clinical guidelines; however, the extent of such effects remains underexplored. Objective: This study aims to evaluate the use of ICD (International Classification of Disease)-coded prescription decision support systems (PDSSs) and the effects of these systems on consultation duration and guideline adherence during telemedicine encounters. Methods: In this retrospective, single-center, observational study conducted from October 2021 to March 2022, adult patients who sought urgent digital care via direct-to-consumer video consultations were included. Physicians had access to current guidelines and could use an ICD-triggered PDSS (which was introduced in January 2022 after a preliminary test in the preceding month) for 26 guideline-based conditions. This study analyzed the impact of implementing automated prescription systems and compared these systems to manual prescription processes in terms of consultation duration and guideline adherence. Results: This study included 10,485 telemedicine encounters involving 9644 patients, with 12,346 prescriptions issued by 290 physicians. Automated prescriptions were used in 5022 (40.67{\%}) of the consultations following system integration. Before introducing decision support, 4497 (36.42{\%}) prescriptions were issued, which increased to 7849 (63.57{\%}) postimplementation. The physician's average consultation time decreased significantly to 9.5 (SD 5.5) minutes from 11.2 (SD 5.9) minutes after PDSS implementation (P<.001). Of the 12,346 prescriptions, 8683 (70.34{\%}) were aligned with disease-specific international guidelines tailored for telemedicine encounters. Primary medication adherence in accordance with existing guidelines was significantly greater in the decision support group than in the manual group (n=4697, 93.53{\%} vs n=1389, 49.14{\%}; P<.001). Conclusions: Most of the physicians adopted the PDSS, and the results demonstrated the use of the ICD-code system in reducing consultation times and increasing guideline adherence. These systems appear to be valuable for enhancing the efficiency and quality of telemedicine consultations by supporting evidence-based clinical decision-making. ",
issn="2291-9694",
doi="10.2196/56681",
url="https://medinform.jmir.org/2024/1/e56681",
url="https://doi.org/10.2196/56681",
url="http://www.ncbi.nlm.nih.gov/pubmed/39453703"
}