Teleconsultation and Clinical Decision Making: a Systematic Review

Kolsoum Deldar, Kambiz Bahaadinbeigy, Seyed Mahmood Tara, Kolsoum Deldar, Kambiz Bahaadinbeigy, Seyed Mahmood Tara

Abstract

Background: The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations.

Method: The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library.

Results: 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles.

Conclusion: The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.

Keywords: decision making; remote consultation; teleconsultation; telemedicine.

Figures

Figure 1
Figure 1
– Selection process of articles
Figure 2
Figure 2
– Time distribution or total retrieved records and accepted articles per year
Figure 3
Figure 3
– Medical fields in adult and pediatric group
Figure 4
Figure 4
Geographical distribution of Inland TCs
Figure 5
Figure 5
Reported effects of teleconsultation on requesting physician
Figure 6
Figure 6
Reported effects based on specialty level of teleconsultation parties

References

    1. Bove AA, Homko CJ, Santamore WP, Kashem M, Kerper M, Elliott DJ. Managing hypertension in urban underserved subjects using telemedicine—a clinical trial. American heart journal. 2013 Apr;165(4):615–21. PubMed PMID: 23537980. Epub2013/03/30. eng.
    1. Remote Consultation–MeSH–NCBI [updated 2016/04/18/05: 55: 49] Available from: .
    1. Agarwal S, Day DJ, Sibson L, Barry PJ, Collas D, Metcalf K, et al. Thrombolysis delivery by a regional telestroke network—experience from the U.K. National Health Service. Journal of the American Heart Association. 2014;3(1):e000408. PubMed PMID: 24572251. Pubmed Central PMCID: PMC3959696. Epub2014/02/28. eng.
    1. Engle X, Aird J, Tho L, Bintcliffe F, Monsell F, Gollogly J, et al. Combining continuing education with expert consultation via telemedicine in Cambodia. Tropical doctor. 2014 Apr;44(2):62–8. PubMed PMID: 24322763. Epub2013/12/11. eng.
    1. Seeber A, Mitterer M, Gunsilius E, Mazzoleni G, Giovannetti R, Farsad M, et al. Feasibility of a multdisciplinary lung cancer videoconference between a peripheral hospital and a comprehensive cancer centre. Oncology. 2013;84(3):186–90. PubMed PMID: 23328311. Epub2013/01/19. eng.
    1. Kwak MJ, Kim JM, Shin IH, Shin SD, Song KJ, Suh GJ, et al. Real-time medical control using a wireless audio-video transmission device in a pre-hospital emergency service in Korea. Journal of telemedicine and telecare. 2009;15(8):404–8. PubMed PMID19948707. Epub2009/12/02. eng.
    1. Reed-Fox A. Patient Online: putting patients in the driving seat of their care. British journal of community nursing. 2015 Apr;20(4):181. PubMed PMID: 25839876. Epub2015/04/04. eng.
    1. Sorknaes AD, Bech M, Madsen H, Titlestad IL, Hounsgaard L, Hansen-Nord M, et al. The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation. Journal of telemedicine and telecare. 2013 Dec;19(8):466–74. PubMed PMID: 24227799. Epub2013/11/15. eng.
    1. Savenstedt S, Zingmark K, Hyden LC, Brulin C. Establishing joint attention in remote talks with the elderly about health: a study of nurses'conversation with elderly persons in teleconsultations. Scandinavian journal of caring sciences. 2005 Dec;19(4):317–24. PubMed PMID: 16324054. Epub 2005/12/06. eng.
    1. Torppa MA, Timonen O, Keinanen-Kiukaanniemi S, Larivaara P, Leiman M. Patient-nurse-doctor interaction in general practice teleconsultations—a qualitative analysis. Journal of telemedicine and telecare. 2006;12(6):306–10. PubMed PMID: 17022839. Epub 2006/10/07. eng.
    1. Nerlich M, Balas EA, Schall T, Stieglitz S-P, Filzmaier R, Asbach P, et al. Teleconsultation Practice Guidelines: Report from G8 Global Health Applications Subproject 4. Telemedicine Journal and e-Health. 2002;8(4):411–8. 2002/12/01.
    1. Epstein RM. Communication between primary care physicians and consultants. Archives of family medicine. 1995 May;4(5):403–9. PubMed PMID: 7742962. Epub 1995/05/01. eng.
    1. Belyansky I, Martin TR, Prabhu AS, Tsirline VB, Howley LD, Phillips R, et al. Poor Resident-Attending Intraoperative Communication May Compromise Patient Safety. Journal of Surgical Research. 2011;171(2):386–94. 12//
    1. Loo L, Puri N, Kim DI, Kawayeh A, Baz S, Hegstad D. “Page Me if You Need Me”: The Hidden Curriculum of Attending-Resident Communication. Journal of Graduate Medical Education. 2012 07/22/received, 12/10/revised, 02/11/revised, 02/25/accepted. 4(3):340–5. PubMed PMID: PMC3444188.
    1. Akkoyun I. The advantages of using photographs and video images in telephone consultations with a specialist in paediatric surgery. African journal of paediatric surgery : AJPS. 2012 May-Aug;9(2):128–31. PubMed PMID: 22878761. Epub2012/08/11. eng.
    1. Walsh C, Cosgrave J, Crean P, Murray D, Walsh R, Kennedy J, et al. Synchronized, interactive teleconferencing with digital cardiac images. Journal of digital imaging. 2006 Mar;19(1):85–91. PubMed PMID: 16249837. Pubmed Central PMCID: PMC3043953. Epub 2005/10/27. eng.
    1. Verhoeven F, van Gemert-Pijnen L, Dijkstra K, Nijland N, Seydel E, Steehouder M. The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review. Journal of medical Internet research. 2007;9(5):e37. PubMed PMID: 18093904. Pubmed Central PMCID: PMC2270420. Epub 2007/12/21. eng.
    1. Brebner JA, Brebner EM, Ruddick-Bracken H. Accident and emergency teleconsultation for primary care—a systematic review of technical feasibility, clinical effectiveness, cost effectiveness and level of local management. Journal of telemedicine and telecare. 2006;12(Suppl1):5–8. PubMed PMID: 16884562. Epub 2006/08/04. eng.
    1. Hersh W, Helfand M, Wallace J, Kraemer D, Patterson P, Shapiro S, et al. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. Journal of telemedicine and telecare. 2002;8(4):197–209. PubMed PMID: 12217102. Epub 2002/09/10. eng.
    1. Hersh WR, Hickam DH, Severance SM, Dana TL, Pyle Krages K, Helfand M. Diagnosis, access and outcomes: Update of a systematic review of telemedicine services. Journal of telemedicine and telecare. 2006;12(Suppl 2):S3–31. PubMed PMID: 16989671. Epub 2006/09/23. eng.
    1. Caffery LJ, Smith AC. A literature review of email-based telemedicine. Studies in health technology and informatics. 2010;161:20–34. PubMed PMID: 21191155. Epub 2010/12/31. eng.
    1. Walsh C, Siegler EL, Cheston E, O'Donnell H, Collins S, Stein D, et al. Provider-to-provider electronic communication in the era of meaningful use: a review of the evidence. Journal of hospital medicine. 2013 Oct;8(10):589–97. PubMed PMID: 24101544. Pubmed Central PMCID: PMC4030393. Epub 2013/10/09. eng.
    1. Bahaadinbeigy K, Yogesan K, Wootton R. MEDLINE versus EMBASE and CINAHL for telemedicine searches. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2010 Oct;16(8):916–9. PubMed PMID: 20925566. Epub 2010/10/12. eng.
    1. Greiner A, Mess WH, Schmidli J, Debus ES, Grommes J, Dick F, et al. Cyber medicine enables remote neuromonitoring during aortic surgery. Journal of vascular surgery. 2012 May;55(5):1227–32. discussion 32-3. PubMed PMID: 22341581. Epub 2012/02/22. eng.
    1. Tamariz F, Merrell R, Popescu I, Onisor D, Flerov Y, Boanca C, et al. Design and implementation of a web-based system for intraoperative consultation. World journal of surgery. 2009 Mar;33(3):448–54. PubMed PMID: 19123027. Epub 2009/01/06. eng.
    1. Ryskal O, Muschinskaja M, Gobel U, Loose KH, Brand H, Nikonova O, et al. Telemicroscopic conferences for children of the Perm territory with suspected or proven malignant solid tumors. Klinische Padiatrie. 2010 May;222(3):199–202. PubMed PMID: 20514632. Epub 2010/06/02. eng.
    1. Bertani A, Launay F, Candoni P, Mathieu L, Rongieras F, Chauvin F. Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance. Orthopaedics & traumatology, surgery & research : OTSR. 2012 Nov;98(7):803–7. PubMed PMID: 23040542. Epub 2012/10/09. eng.
    1. Froehlich W, Seitaboth S, Chanpheaktra N, Pugatch D. Case report: an example of international telemedicine success. Journal of telemedicine and telecare. 2009;15(4):208–10. PubMed PMID: 19471034. Epub 2009/05/28. eng.
    1. Mora F, Cone S, Rodas E, Merrell RC. Telemedicine and electronic health information for clinical continuity in a mobile surgery program. World journal of surgery. 2006 Jun;30(6):1128–34. PubMed PMID: 16736347. Epub 2006/06/01. eng.
    1. Shanks L, Masumbuko EW, Ngoy NM, Maneno M, Bartlett S, Thi SS, et al. Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2012 Aug;16(8):1066–8. PubMed PMID: 22565108. Epub 2012/05/09. eng.
    1. Ohno G, Watanabe K, Okada Y, Higuchi K. Practical experience of telehealth between an Antarctic station and Japan. Journal of telemedicine and telecare. 2012 Dec;18(8):473–5. PubMed PMID: 23209273. Epub 2012/12/05. eng.
    1. Otto C, Shemenski R, Scott JM, Hartshorn J, Bishop S, Viegas S. Evaluation of tele-ultrasound as a tool in remote diagnosis and clinical management at the Amundsen-Scott South Pole Station and the McMurdo Research Station. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2013 Mar;19(3):186–91. PubMed PMID: 23480714. Epub 2013/03/14. eng.
    1. Otto CA, Shemenski R, Drudi L. Real-time tele-echocardiography: diagnosis and management of a pericardial effusion secondary to pericarditis at an Antarctic research station. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2012 Sep;18(7):521–4. PubMed PMID: 22822790. Epub 2012/07/25. eng.
    1. Callahan CW, Malone F, Estroff D, Person DA. Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation. Archives of pediatrics & adolescent medicine. 2005 Apr;159(4):389–93. PubMed PMID: 15809396. Epub 2005/04/06. eng.
    1. Harley J. Economic evaluation of a tertiary telepsychiatry service to an island. Journal of telemedicine and telecare. 2006;12(7):354–7. PubMed PMID: 17059652. Epub 2006/10/25. eng.
    1. Stutchfield BM, Jagilly R, Tulloh BR. Second opinions in remote surgical practice using email and digital photography. ANZ journal of surgery. 2007 Nov;77(11):1009–12. PubMed PMID: 17931268. Epub 2007/10/13. eng.
    1. Syed-Abdul S, Scholl J, Chen CC, Santos MD, Jian WS, Liou DM, et al. Telemedicine utilization to support the management of the burns treatment involving patient pathways in both developed and developing countries: a case study. Journal of burn care & research : official publication of the American Burn Association. 2012 Jul-Aug;33(4):e207–12. PubMed PMID: 22249104. Epub 2012/01/18. eng.
    1. Costanzo G, Monari P. Experience with asynchronous medical teleconsultation in the Alliance of the Italian hospitals worldwide. Journal of telemedicine and telecare. 2006;12(8):382–6. PubMed PMID: 17227601. Epub 2007/01/18. eng.
    1. Zolfo M, Bateganya MH, Adetifa IM, Colebunders R, Lynen L. A telemedicine service for HIV/AIDS physicians working in developing countries. Journal of telemedicine and telecare. 2011;17(2):65–70. PubMed PMID: 21078680. Epub 2010/11/17. eng.
    1. Blank E, Lappan C, Belmont PJ, Jr, Machen MS, Ficke J, Pope R, et al. Early analysis of the United States Army's telemedicine orthopaedic consultation program. Journal of surgical orthopaedic advances. 2011 Spring;20(1):50–5. PubMed PMID: 21477534. Epub 2011/04/12. eng.
    1. Maddry JK, Sessions D, Heard K, Lappan C, McManus J, Bebarta VS. Wartime toxicology: evaluation of a military medical toxicology telemedicine consults service to assist physicians serving overseas and in combat (2005-2012) Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2014 Sep;10(3):261–5. PubMed PMID: 24752493. Pubmed Central PMCID: PMC4141918. Epub 2014/04/23. eng.
    1. McManus J, Salinas J, Morton M, Lappan C, Poropatich R. Teleconsultation program for deployed soldiers and healthcare professionals in remote and austere environments. Prehospital and disaster medicine. 2008 May-Jun;23(3):210–6. discussion 7. PubMed PMID: 18702266. Epub 2008/08/16. eng.
    1. Mines MJ, Bower KS, Lappan CM, Mazzoli RA, Poropatich RK. The United States Army Ocular Teleconsultation program 2004 through 2009. American journal of ophthalmology. 2011 Jul;152(1):126–32.e2. PubMed PMID: 21570049. Epub 2011/05/17. eng.
    1. Rand ER, Lappan CM, Lee JC, Furgerson JL. Paging the worldwide cardiology consultant: the Army Knowledge Online Telemedicine Consultation Program in cardiology. Military medicine. 2009 Nov;174(11):1144–8. PubMed PMID: 19960820. Epub 2009/12/08. eng.
    1. Schmidt T, Lappan CM, Hospenthal DR, Murray CK. Deployed provider satisfaction with infectious disease teleconsulation. Military medicine. 2011 Dec;176(12):1417–20. PubMed PMID: 22338358. Epub 2012/02/18. eng.
    1. Waterman BR, Laughlin MD, Belmont PJ, Jr, Schoenfeld AJ, Pallis MP. Enhanced casualty care from a Global Military Orthopaedic Teleconsultation Program. Injury. 2014 Nov;45(11):1736–40. PubMed PMID: 24810665. Epub 2014/05/09. eng.
    1. Kadaba V, Ly T, Noor S, Chhut SV, Hinsch N, Stauch G, et al. A hybrid approach to telepathology in Cambodia. Journal of telemedicine and telecare. 2013 Dec;19(8):475–8. PubMed PMID: 24197402. Epub 2013/11/08. eng.
    1. Helveston EM, Neely DE, Cherwek DH, Smallwood LM. Diagnosis and management of strabismus using telemedicine. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2008 Aug;14(6):531–8. PubMed PMID: 18729751. Epub 2008/08/30. eng.
    1. Hu SW, Foong HB, Elpern DJ. Virtual Grand Rounds in Dermatology: an 8-year experience in web-based teledermatology. International journal of dermatology. 2009 Dec;48(12):1313–9. PubMed PMID: 20415672. Epub 2010/04/27. eng.
    1. Massone C, Soyer HP, Hofmann-Wellenhof R, Di Stefani A, Lozzi GP, Gabler G, et al. Two years'experience with Web-based teleconsulting in dermatology. Journal of telemedicine and telecare. 2006;12(2):83–7. PubMed PMID: 16539755. Epub 2006/03/17. eng.
    1. Patterson V, Wootton R. A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists. Global health action. 2013;6:21465. PubMed PMID: 24063752. Pubmed Central PMCID: PMC3782613. Epub 2013/09/26. eng.
    1. Borve A, Dahlen Gyllencreutz J, Terstappen K, Johansson Backman E, Aldenbratt A, Danielsson M, et al. Smartphone teledermoscopy referrals: a novel process for improved triage of skin cancer patients. Acta dermato-venereologica. 2015 Feb;95(2):186–90. PubMed PMID: 24923283. Epub 2014/06/14. eng.
    1. Webb CL, Waugh CL, Grigsby J, Busenbark D, Berdusis K, Sahn DJ, et al. Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2013 Sep;26(9):1090–8. PubMed PMID: 23860093. Epub 2013/07/19. eng.
    1. Wallace DL, Smith RW, Pickford MA. A cohort study of acute plastic surgery trauma and burn referrals using telemedicine. Journal of telemedicine and telecare. 2007;13(6):282–7. PubMed PMID: 17785024. Epub 2007/09/06. eng.
    1. Desai S, Williams ML, Smith AC. Teleconsultation from a secondary hospital for paediatric emergencies occurring at rural hospitals in Queensland. Journal of telemedicine and telecare. 2013 Oct;19(7):405–10. PubMed PMID: 24218355. Epub 2013/11/13. eng.
    1. Donnem T, Ervik B, Magnussen K, Andersen S, Pastow D, Andreassen S, et al. Bridging the distance: a prospective tele-oncology study in Northern Norway. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2012 Sep;20(9):2097–103. PubMed PMID: 22076621. Epub 2011/11/15. eng.
    1. Lasierra N, Alesanco A, Gilaberte Y, Magallon R, Garcia J. Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations. International journal of medical informatics. 2012 May;81(5):332–43. PubMed PMID: 22425394. Epub 2012/03/20. eng.
    1. Waldura JF, Neff S, Dehlendorf C, Goldschmidt RH. Teleconsultation improves primary care clinicians'confidence about caring for HIV. Journal of general internal medicine. 2013 Jun;28(6):793–800. PubMed PMID: 23371417. Pubmed Central PMCID: PMC3663958. Epub 2013/02/02. eng.
    1. Joseph B, Hadeed G, Sadoun M, Rhee PM, Weinstein RS. Video consultation for trauma and emergency surgical patients. Critical care nursing quarterly. 2012 Oct-Dec;35(4):341–5. PubMed PMID: 22948367. Epub 2012/09/06. eng.
    1. Eminovic N, de Keizer NF, Wyatt JC, ter Riet G, Peek N, van Weert HC, et al. Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial. Archives of dermatology. 2009 May;145(5):558–64. PubMed PMID: 19451500. Epub 2009/05/20. eng.
    1. Shaikh N, Lehmann CU, Kaleida PH, Cohen BA. Efficacy and feasibility of teledermatology for paediatric medical education. Journal of telemedicine and telecare. 2008;14(4):204–7. PubMed PMID: 18534955. Epub 2008/06/07. eng.
    1. Handschu R, Scibor M, Willaczek B, Nuckel M, Heckmann JG, Asshoff D, et al. Telemedicine in acute stroke: remote video-examination compared to simple telephone consultation. Journal of neurology. 2008 Nov;255(11):1792–7. PubMed PMID: 19156491. Epub 2009/01/22. eng.
    1. Hasselberg M, Beer N, Blom L, Wallis LA, Laflamme L. Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction. PloS one. 2014;9(6):e98539. PubMed PMID: 24887257. Pubmed Central PMCID: Pmc4041890. Epub 2014/06/03. eng.
    1. Farber N, Haik J, Liran A, Weissman O, Winkler E. Third generation cellular multimedia teleconsultations in plastic surgery. Journal of telemedicine and telecare. 2011;17(4):199–202. PubMed PMID: 21508079. Epub 2011/04/22. eng.
    1. Dehours E, Valle B, Bounes V, Girardi C, Tabarly J, Concina F, et al. User satisfaction with maritime telemedicine. Journal of telemedicine and telecare. 2012 Jun;18(4):189–92. PubMed PMID: 22604271. Epub 2012/05/19. eng.
    1. Dharmar M, Romano PS, Kuppermann N, Nesbitt TS, Cole SL, Andrada ER, et al. Impact of critical care telemedicine consultations on children in rural emergency departments. Critical care medicine. 2013 Oct;41(10):2388–95. PubMed PMID: 23921273. Epub 2013/08/08. eng.
    1. Ignatius E, Perala S, Makela K. Use of videoconferencing for consultation in dental prosthetics and oral rehabilitation. Journal of telemedicine and telecare. 2010;16(8):467–70. PubMed PMID: 21030487. Epub 2010/10/30. eng.
    1. Jacob MK, Larson JC, Craighead WE. Establishing a telepsychiatry consultation practice in rural Georgia for primary care physicians: a feasibility report. Clinical pediatrics. 2012 Nov;51(11):1041–7. PubMed PMID: 22523276. Epub 2012/04/24. eng.
    1. McFarland LV, Raugi GJ, Reiber GE. Primary care provider and imaging technician satisfaction with a teledermatology project in rural Veterans Health Administration clinics. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2013 Nov;19(11):815–25. PubMed PMID: 24053115. Epub 2013/09/24. eng.
    1. Armfield NR, Donovan T, Bensink ME, Smith AC. The costs and potential savings of telemedicine for acute care neonatal consultation: preliminary findings. Journal of telemedicine and telecare. 2012 Dec;18(8):429–33. PubMed PMID: 23148301. Epub 2012/11/14. eng.
    1. Bagayoko CO, Traore D, Thevoz L, Diabate S, Pecoul D, Niang M, et al. Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali. BMC health services research. 2014;14(Suppl 1):S9. PubMed PMID: 25080312. Pubmed Central PMCID: PMC4108933. Epub 2014/08/01. eng.
    1. Horner K, Wagner E, Tufano J. Electronic consultations between primary and specialty care clinicians: early insights. Issue Brief (Commonw Fund). 2011. 2011;23:1–14. eng.
    1. Mark DA, Fitzmaurice GJ, Haughey KA, O'Donnell ME, Harty JC. Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model. International journal of clinical practice. 2011 Oct;65(10):1100–7. PubMed PMID: 21923849. Epub 2011/09/20. eng.
    1. Bodenheimer T. Coordinating care—a perilous journey through the health care system. The New England journal of medicine. 2008 Mar 6;358(10):1064–71. PubMed PMID: 18322289. Epub 2008/03/07. eng.
    1. Mehrotra A, Forrest CB, Lin CY. Dropping the baton: specialty referrals in the United States. The Milbank quarterly. 2011 Mar;89(1):39–68. PubMed PMID: 21418312. Pubmed Central PMCID: Pmc3160594. Epub 2011/03/23. eng.
    1. O'Malley AS, Tynan A, Cohen GR, Kemper N, Davis MM. Coordination of care by primary care practices: strategies, lessons and implications. Research brief. 2009 Apr;(12):1–16. PubMed PMID: 19452679. Epub 2009/05/21.
    1. Masic I, Novo A. Medical informatics education in Bosnia and Herzegovina. Acta Inform Med. 2005;13(4):184–8.
    1. Masic I, Pandza H, Kulasin I, Masic Z, Valjevac S. Tele-education as method of medical education. Med Arh. 2009;63(6):350–3.
    1. Masic I, Ciric D, Pulja A, Kulasin I, Pandza H. Quality assessment of medical education and use of information technoloin Health Technologies and Informatics. 2009:898–902.

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