E-consult adoption depends on perceptions of clinicians

Implementation of electronic consultations (e-consults) could improve providing specialty care, but their worth changes depending on clinician’s perceptions of the potential benefits of the technology. Findings were published in the February issue of Health Affairs.

E-consults have the ability to connect patient and provider without the hassle of travel and wait times. Additionally, access to specialty care is more easily attained by a wider variety of patients. In this study, researchers examined the variability in e-consults used in anesthesiology departments with the Veterans Affairs New England Healthcare System (VANEHS).

“E-consults can provide a benefit that traditional face-to-face consults cannot, as they have the potential to improve the efficiency and timeliness of services,” wrote first author Melissa Afable and colleagues. “With an increasing number of hospitals and health systems now using EHRs as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, e-consults have the potential for wide dissemination.”

The study found a swift increase in e-consults for anesthesiology from 2012 to 2015 with 103 e-consultations in 2012 increasing to 5,023 e-consultations in 2015. Additionally, e-consults were utilized in many different ways including for preoperative assessments to use for only low-risk patients or no use.

Researchers noted a difference in the perceived impact of e-consults on factors of workflow and patient-centeredness in interviews with stakeholders. Clinicians at sites where e-consults were highly utilized reported the technology was able to improve workflow efficiency, but clinicians at low e-consults utilization sites favored in-person visits for some or all of their patients.

“The increasing adoption of e-consultation in health care systems and e-consults’ promise for improving access while controlling costs under new payment models make e-consults an attractive intervention,” concluded Afabale and colleagues. “The impact of e-consults on overall efficiency as a result of potential work shifting to other specialties and an assessment of medical outcomes need further examination. The operational efficiencies and improved patient and provider satisfaction attributable to the adoption of preoperative e-consults suggest that this innovation is not solely a tool for primary care providers to access specialty care.”