eConsult implementation increasing, improving specialty appointments

The implementation of eConsult systems are allowing patients to gain access to specialists and receiving more quickly, according to a study in Health Affairs that examined the benefits of eConsulting and specialty care.

The obstacles involved in visiting specialists could be removed by eConsulting. But what other benefits do the systems bring to healthcare? First author Michael L. Barnett and colleagues tackled this question in a retrospective analysis of eConsult systems in the Los Angeles County Department of Health Services (DHS) between 2012 and 2015.

Researchers used a database covering the main points of specialty requested, data of request, disposition of the visits, number of exchanges between patient and physicians and the date of visits to measure benefits of eConsults. The analysis covered two separate studies on the implementation of eConsult systems at DHS. The first study included the entire population of physicians and patients using eConsult, totaling more than 395,050, and included measures for the rate of adoption and total use of eConsult. The second study included many major points in the analysis and covered eConsults from the third and fourth year of implementation.

“One potential benefit is that it facilitates the education of primary care providers through eConsult discussions,” wrote Barnett and colleagues. “Over time, there could be less need for primary care providers to send eConsult requests for easily manageable issues.”

Overall, the eConsult program covered 43 DHS facilities and more than 200 non-DHS practices from 2012 to 2015. Results showed that, after initial implementation, eConsult requests grew quickly, from 86 in the third quarter of 2012 to 12,082 at the end of 2015. eConsults were used by 3,060 primary care physicians and 479 specialists by the end of 2015.

The median time for a first response by a specialist through eConsult was measured at less than one day, with 25 percent of these encounters ending when the specialist concluded there was no need for a visit. Between 2014 and 2015, the median time for any eConsult request that was followed by a visit fell 17.4 percent. eConsults also increased the number of appointments scheduled within 30 days by 6.2 percent.

“The results presented here are encouraging, but they also show significant room for improvement,” concluded Barnett and colleagues. “For example, even though wait times for a specialist visit are a crude measure of access, a median wait time of fifty-two days is still high. One way to drive further improvement could be to address the wide variation in the rate of eConsult requests resolved without a visit across specialist reviewers. eConsult implementation in the DHS demonstrates the capacity for a large public health system to use technology-assisted communication between primary care providers and specialists to reduce the key gap in access to timely specialty care for the underserved.

"eConsult adoption was rapid, without creating additional strain on specialty access because of pent-up demand. We also observed wide variation among specialist reviewers in the rate of requests they resolved without a visit, some of which may be attributable to reviewers’ engagement in the eConsult model.”