Electronic Consultation (E-Consult)

Electronic consultation (e-consult), a telehealth modality, is a mechanism that enables primary care providers (PCPs) to obtain specialists' inputs into a patient's care treatment without requiring the patient to go to a face-to-face visit.

E-consult is a web-enabled system and process, where PCPs and specialists are able to communicate, share clinical information and consult electronically to manage patient care. It reduces the specialty referral and appointment process to just a few days, which increases the speed delivery for patient care services.

Closed health systems with existing electronic health record (EHR) can incorporate e-consult services into the system, making start-up cost minimal. Open health systems must create a secured website portal to utilize e-consult service due to discrepancy in their respective EHR systems.

Mayo Clinic researchers estimated that their system could avoid 1,800 specialty consultations and subsequently reduce direct costs by $450,000 annually, if each provider orders e-consultations two to three times every month.

Additionally, Mayo Clinic’s e-consult resulted in a shorter time frame of 1 day and 6 hours, compared to 7 days and 20 hours for traditional consultation. In a study at San Francisco General Hospital, 60% of PCPs reported better access for non-urgent issues, and 54% reported shorter wait times for arranging a new appointment with a specialist.

Due to better transfer of skills from specialists to PCPs, general practitioners for chronic kidney disease in the UK reported more confidence in managing the condition. Also, clinicians reported less interrupted workflow due to asynchronous communication. A specialist survey at Mayo Clinic agreed that e-consult was less disruptive than consultations by telephone or pager by 67%. And at the San Francisco General Hospital there was a reduction of 2.1% in inappropriate specialty referrals by the surgical specialty clinicians compared to 9.8% of paper-based referrals. PCPs also saw improvements in their ability to track referrals by 89%.

Disadvantage of e-consult is workload shift from specialist or administrative staff to PCPs. Tasks, usually performed by administrative staff such as tracking referral process and correcting errors, are PCP's responsibility in the e-consultation system. Moreover, PCPs are responsible for completing the prior work-up that the specialist requests, whereas such work was done by specialist as necessary in the paper referral system.

Under the Balanced Budget Act of 1997 (BBA), only services provided to rural Health Professional Shortage Areas were eligible for reimbursement. With the changing Medicare requirements, hospitals are beginning to utilize technology to meet Accountable Care Organization (ACO) requirements. The American Recovery and Reinvestment Act of 2009 (ARRA) allocated $417 billion to the Federal Communications Commission (FCC) to implement national broadband networks. Additional grants are available and can be found at the Health Resources and Services Administration (HRSA).

...
Wikipedia