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Related Experiment Video

Updated: Jun 2, 2026

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

Paper persistence, workarounds, and communication breakdowns in computerized consultation management.

Jason J Saleem¹, Alissa L Russ, Adam Neddo

¹VA HSR&D Center on Implementing Evidence-Based Practice, Roudebush VA Medical Center, Indianapolis, IN 46202, United States. Jason.Saleem@va.gov

International Journal of Medical Informatics

|May 3, 2011

Summary

Electronic outpatient consult management in the Veterans Health Administration (VHA) faces challenges like paper persistence and communication issues. Addressing these can improve care coordination and tracking of medical consults.

Related Experiment Videos

Last Updated: Jun 2, 2026

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

Area of Science:

Health Informatics
Medical Systems Engineering
Healthcare Management

Background:

The outpatient consult process between primary care and specialty services is often hindered by paper-based workflows.
Inefficiencies and communication breakdowns in consult management can negatively affect patient care quality.
Existing electronic systems present challenges that require investigation within the Veterans Health Administration (VHA).

Purpose of the Study:

To investigate the current challenges within the electronic outpatient consult management process in the United States Veterans Health Administration (VHA).

Main Methods:

Ethnographic observation and semi-structured interviews were conducted in nine specialty and three primary care clinics at a VAMC.
Data from 16 healthcare workers were collected through observations and interviews.
A national query of electronic error and enhancement requests (E3Rs) related to the consult package in the VA's electronic health record (EHR) from 2005-2009 was analyzed.

Main Results:

Observed instances of paper persistence, workarounds, communication failures, and redundancies in computerized consult management.
Analysis of E3Rs identified needs for enhancements in reporting, configuration/customization, and user interface.
Identified challenges impact the efficiency and tracking of electronic outpatient consults.

Conclusions:

Understanding the identified challenges is crucial for improving the electronic outpatient consult management process.
Enhanced informatics tools integrated into clinical workflows can support better care coordination and consult tracking.
Addressing system inefficiencies can lead to improved delivery of quality medical care.