In its field report, providers at UC Irvine’s Department of Medicine review the implementation of its custom built e-consult system and its impact on specialty care access for the 3.5 million people served by its academic healthcare system. A unique element of the program, launched in April 2015, was an EHR transition from Allscripts to Epic, which included a shift from a document-based e-consult workflow to a process integrated with the EHR. The program resulted in both workflow efficiencies and the establishment of a steering committee of health system leadership and providers that conducted training and orientation sessions for the system’s specialists and primary care providers.
At the start of 2020, the Ohio State University Wexner Medical Center’s new Center for Primary Care Innovation and Transformation launched a virtual care initiative that includes email interactions, telephone calls, video visits and e-consults. A few weeks after the COVID-19 surge, virtual care tool adoption grew from 5% to 93%. To support PCP training requests, the program convened a multi-disciplinary team including “physicians, electronic health record (EHR) and information technology (IT) professionals, process improvement and ambulatory leadership, communications experts, and patient experience advocates.” The authors, who include E-Consult Workgroup member J. Nwando Olayiwola, MD, conclude that “recommendations, best practices, lessons learned, and strategies to thrive in an ever-changing landscape will become core to the new norm in primary care.”
An evaluation of e-consult implementation conducted leadership interviews and analyzed e-consult platform metrics for 5 publicly financed, California county-based health systems that each serve 40,000 to 180,000 culturally and linguistically diverse patients across 4 to 19 primary care locations. The study concludes that successful e-consult implementation leverage prior primary care and specialty care clinician relationships and integrate EHR and e-consult platforms.
“eConsults and Learning Between Primary Care Providers and Specialists” Family Medicine, July-August 2019
An assessment of primary care providers view on e-consults’ reviewed free-text comments included in closeout surveys. In their free-text comments, PCPs “described eConsult’s ability to foster stronger relationships with specialists, deliver responses that provided teaching in multiple areas of their practice, and support further learning”, demonstrating e-consults’ educational value for providers.
“Electronic consultation impact from the primary care clinician perspective: Outcomes from a national sample” Journal of Telemedicine and Telecare, July 2018
In a retrospective analysis of provider-reported e-consult outcomes from March 2017 to January 2018, 75% of primary care clinicians reported improved care plans and 50% reported educational benefits. Conclusion: “Findings suggest that eConsults demonstrate important educational benefits, but may also influence PCC decision-making in a way that yields tremendous cost-saving potential and improved patient experience.”
“Optimizing Electronic Consultation Between Primary Care Providers and Psychiatrists: Mixed-Methods Study” Journal of Medical Internet Research, April 2018
This mixed-methods study converges quatitative data from pychiatric e-consults and qualitative data from primary care provider interviews into recommendations to expand the use of econsults between PCPs and psychiatrists. The study’s authors conclude, “E-consult is a viable and timely way for PCPs to get much-needed psychiatric advice. For optimizing its utility and uptake, e-consult needs to be integrated into reliable care pathways with adequate referrer and consultant preparation.”
“Unique Educational Opportunities for [Primary Care Providers] and Specialists Arising From Electronic Consultation Services”Academic Medicine, January 2017
“Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System” Journal of Medical Internet Research, December 2016