New technologies can change healthcare delivery. Cisco HealthPresence, an integrated platform that combines video, audio, and call center technology with medical information to create a virtual clinic experience, was piloted on emergency department patients. The aim was to assess primary care consultations. Patients were supported by an assistant. The doctor was remote from the patient and collected details and a recommended management plan. The same doctor re-examined the patient face-to-face. All patients completed a questionnaire about the experience. Key staff and a small sample of patients were interviewed. One hundred and five (N = 105) patients were included; 42% were given advice, 25% were prescribed analgesia, 26% were prescribed antibiotics, and 15% were x-rayed. There were early problems with the digital stethoscope. Doctors reported that the management plan changed in 7% of cases after seeing the patient. At least 90% of patients reported a positive experience. All patients and staff interviewed were positive. Staff found equipment to be valid and reliable; a concern was the inability to perform "hands on" examination. Telemedicine requires a change in the way of consulting and staff must be interested in using the technology to understand the differences. As one of the doctors said, "HealthPresence was a positive experience." Greater numbers would be required to validate key findings. As judged by clinicians, HealthPresence was successful and potentially safe for triage of unscheduled cases. Different types of staffing models need to be considered to ensure optimum use of health professionals. This study has shown that, despite some limitations, most HealthPresence consultations were found to be safe and appropriate. Further study of this consultation technology is required. HealthPresence has the potential to transform access to services for many patients, and to improve the effectiveness of delivery across a number of services.
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