Abstract
BackgroundTo evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology.MethodsWe conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from 1/2015–3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals.ResultsThere were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% did not have an in-person visit after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 – January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant.ConclusionE-consults are an effective way to address positive ANA consults without significant increase in resource utilization and were temporally associated with decreased wait times for in-person visits.
Highlights
To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology
An Electronic health record (EHR) is used by all providers throughout this system and any provider within the system can order a referral for specialty care
The referring provider places an order for a referral to rheumatology in the EHR; reason for consult is entered into a free text box within the referral order
Summary
To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology. Prior studies have shown the benefit of synchronous telehealth modalities within rheumatology such as videoconference visits [5,6,7,8,9], but there is little published about (2020) 4:54 the impact of asynchronous E-consults. Scheibe et al [10], reviewed the impact of another type of asynchronous telehealth format, the pre-consult exchange, which uses a similar strategy as E-consults, but with more integrated communication between the referring provider and specialist. One study evaluated E-consults in rheumatology and showed advantages including quicker turn-around times, a decrease in face-to-face visits, and increased referring provider satisfaction. Common reasons E-consults were utilized in this study included treatment questions, questions about whether a patient required an in-person evaluation, and interpretation of a positive laboratory test [2]
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