%0 Journal Article
%@ 2291-9694
%I JMIR Publications
%V 12
%N 
%P e56681
%T The Impact of International Classification of Disease–Triggered Prescription Support on Telemedicine: Observational Analysis of Efficiency and Guideline Adherence
%A Accorsi,Tarso Augusto Duenhas
%A Eduardo,Anderson Aires
%A Baptista,Carlos Guilherme
%A Moreira,Flavio Tocci
%A Morbeck,Renata Albaladejo
%A Köhler,Karen Francine
%A Lima,Karine de Amicis
%A Pedrotti,Carlos Henrique Sartorato
%+ Telemedicine Department, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627 - Bloco B, 2º andar, Secretaria da Unidade de Telemedicina, São Paulo, 05652-900, Brazil, 55 1121515420, taccorsi@einstein.br
%K telemedicine
%K clinical decision support systems
%K electronic prescriptions
%K guideline adherence
%K consultation efficiency
%K International Classification of Disease–coded prescriptions
%K teleheath
%K eHealth
%D 2024
%7 25.10.2024
%9 Original Paper
%J JMIR Med Inform
%G English
%X 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. 
%M 39453703
%R 10.2196/56681
%U https://medinform.jmir.org/2024/1/e56681
%U https://doi.org/10.2196/56681
%U http://www.ncbi.nlm.nih.gov/pubmed/39453703