E-consultations improve timely access to specialists

E-consultations hold great potential for improving access to specialist advice in a timelier manner than the traditional referral-consultation process, according to a study published in Telemedicine and e-Health.

Erin Keely, MD, hospital chief, division of endocrinology and metabolism at Ottawa Hospital in Canada, and colleagues built a system on an existing, secure web-based “regional collaboration space” that was established by the Local Health Integration Network and hosted within a community hospital. In the study, the primary care physicians (PCPs) and designated delegates could access this portal, through which they can submit a patient-specific clinical question to a specialty service.

In the pilot, specialists received a notification via e-mail, which included a link to the secure website, alerting them that an e-consult was waiting for their response. From there, the specialist accessed the clinical question and then provided recommendations that required no face-to-face follow-up, recommended additional information or recommended a formal referral.

Researchers collected all e-consultations from the project's pilot phase, which took place from April 1, 2011 to June 30, 2012.

Of the 406 e-consultations submitted by 59 PCPs to 16 specialty services, the specialist provided an answer without requiring further information in 89 percent of the cases. About 90 percent of the cases took less than 15 minutes for the specialist to complete.

The service was perceived as highly beneficial to providers and patients in more than 90 percent of the cases, according to the study. In 43 percent of submitted cases, a traditional referral originally contemplated was entirely avoided.

“The potential impact of e-consultations includes not only how many face-to face consultations can be avoided and reducing wait times, but can also improve communication between primary and specialty care,” wrote Keely et al.