Use Of eConsults Research Articles

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care. To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months). Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period. In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care. Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

Exploring Patterns and Disparities in E-Consult Referrals: An Analysis of Patient and Community Factors in Colorado Health Care.

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.

The impact of hematology electronic consultations on the management of iron deficiency.

Delays in the evaluation and treatment of iron deficiency can lead to increased disease-related morbidity and mortality. Electronic consultation (e-consult) is a referral modality that allows providers quicker access to recommendations from a specialist based on electronic chart review. While the use of e-consult is expanding in classical hematology, gaps exist in the understanding of patient outcomes related to its use for iron deficiency. We randomly selected 200 e-consults and 200 traditional referrals from 3,336 hematology referrals for iron deficiency at a single center. The primary outcomes of the retrospective analysis were: time to completion of the referral, and time to treatment with intravenous iron. Secondary outcomes included recurrence of iron deficiency, need for repeat e-consult, conversion to in-person evaluation, and assessment of whether the etiology of iron deficiency was addressed. E-consults significantly reduced the time from referral to intravenous iron repletion (e-consult, 33 days; traditional referral, 68 days; p < .05). Assessment of the underlying etiology occurred in 70.7% of the e-consult encounters compared to 92.5% of traditional referrals (p < .05). These findings highlight advantages of e-consults in improving care delivery in iron deficiency, and identifying gaps that can be improved through practice standardization to ensure equitable, high-value care.

From Clinic to Kitchen to Electronic Health Record: The Background and Process of Building a Culinary Medicine eConsult Service.

Diet plays a pivotal role in health outcomes, influencing various metabolic pathways and accounting for over 20% of risk-attributable disability adjusted life years (DALYs). However, the limited time during primary care visits often hinders comprehensive guidance on dietary and lifestyle modifications. This paper explores the integration of electronic consultations (eConsults) in Culinary Medicine (CM) as a solution to bridge this gap. CM specialists, with expertise in the intricate connections between food, metabolism, and health outcomes, offer tailored dietary recommendations through asynchronous communication within the electronic health record (EHR) system. The use of CM eConsults enhances physician-patient communication and fosters continuous medical education for requesting clinicians. The benefits extend directly to patients, providing access to evidence-based nutritional information to address comorbidities and improve overall health through patient empowerment. We present a comprehensive guide for CM specialist physicians to incorporate CM eConsults into their practices, covering the historical context of eConsults, their adaptation for CM, billing methods, and insights from the implementation at UT Southwestern Medical Center. This initiative delivers expanded access to patient education on dietary risks and promotes interprofessional collaboration to empower improved health.

Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study.

Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value.

Impact of Pharmacist Expertise on Acceptance Rates in a Comprehensive E-Consult Program within a Large Academic Health System.

Background: Although electronic consults (e-consults) are utilized in healthcare systems by medical professionals, use of e-consults by pharmacy remains novel outside of niche disease states. Additional research is required to fill literature gaps to assist in optimizing the pharmacist's role in e-consult programs. Objective: This study aimed to assess the impact of pharmacist expertise on e-consult outcomes. Methods: This study was a retrospective review of all pharmacy e-consults completed by pharmacists at a large academic health system between March 1st, 2020, and August 31st, 2022. This was deemed quality improvement and did not require Institutional Review Board approval. E-consults were identified using a report. Key data collection points included e-consult disease state, ordering provider, pharmacists' specialty, and recommendation result. The primary outcome was the difference in acceptance rates of expert versus non-expert pharmacist recommendations. Secondary outcomes included the overall implementation rate, implementation rate over time, acceptance rate between provider types, time to implementation, and pharmacist response time. Acceptance rates were compared between expert/non-expert dichotomy via Pearson chi-square test. Results: A total of 375 e-consults met inclusion criteria and spanned 19 unique disease states. The three most common included diabetes mellitus (27.0%), pain management (13.1%), and mental health (11.0%). Nearly 60% of e-consults were in a disease with an expert. The provider acceptance rate was higher when e-consults were completed by an expert versus non-expert (62.6% versus 39.6% respectively, p = 0.002). The overall implementation rate was 51.8%. Physicians (MD/DOs) accepted the pharmacist's recommendations 55.6% of the time, advanced practice registered nurses (APRNs) 64.7%, physician assistants (PAs) 100.0%, and other professionals 25.0% (p = 0.033). Mean time to recommendation implementation was 16.5 days (SD = 29.4 days). Mean time to pharmacist response was 1.1 days (SD = 1.4 days). Conclusions: Comprehensive e-consult programs are more successful when integrating expert pharmacists.

EConsult Provides a Novel Opportunity to Evaluate Hematuria Referrals for Medicaid Patients in the "Real-World" Community.

We utilized an eConsult program to assess the appropriateness and completeness of hematuria evaluation among one of the largest Medicaid networks in California, the Inland Empire Health Plan. We retrospectively reviewed all hematuria consults from May 2018 to August 2020. Patient demographic and clinical data were extracted from the electronic health record and dialogues between primary care provider and specialist including laboratory results and imaging. We calculated the proportions of imaging types and the outcome of the eConsults among patients. χ2 and Fisher's exact tests were used for statistical analysis. A total of 106 hematuria eConsults were submitted. Primary care provider evaluation for risk factors rates were low: 37% gross hematuria, 29% voiding symptoms/dysuria, 49% other urothelial risk factors or benign etiology, and 63% smoking. Only 50% of all referrals were deemed appropriate based on a history of gross hematuria or ≥3 red blood cells/high-power field on urinalysis without evidence of infection or contamination. Thirty-one percent of patients received a renal ultrasound, 2.8% received CT urography, 5.7% received other cross-sectional imaging, and 64% received no imaging. By the conclusion of the eConsult only 54% of patients were referred for a face-to-face visit. The use of eConsults allows for urological access in the safety-net population and presents a means to assess the urological needs in the community. Our findings suggest eConsults represent an opportunity to reduce the morbidity and mortality associated with hematuria among safety-net patients who are otherwise less likely to receive a proper evaluation.

Use of eConsult to enhance genetics service delivery in primary care: A multimethod study.

Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care. PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out. In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies. eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.

Electronic consultation in correctional facilities worldwide: a scoping review

ObjectiveTo provide an overview of the use of and evidence for eConsult in correctional facilities worldwide.DesignScoping review.Data sourcesThree academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published...

897-P: Use of In-Person and E-Consults for Type 2 Diabetes in an Academic Primary Care Network

Objective: Electronic consults (e-consults) are asynchronous clinician-to-clinician communications within an electronic health record (EHR) . We compared characteristics of patients for whom electronic versus in-person consults for type 2 diabetes (T2D) were ordered in an academic primary care network. Methods: E-consult and in-person consults ordered for T2D between January 1 and December 31, 20by primary care providers who ordered both referral types were included. Patient characteristics were extracted from an EHR repository. E-consult content was reviewed by a physician. Characteristics of e-consults and in-person consults were compared with chi-squared tests and t-tests. Results: E-consults accounted for 48.4% of consults (156 of 322) . Compared with in-person consult patients, e-consult patients were older (62.1±14.1 vs. 56.7±13.9 years, p&amp;lt;0.001) , more likely to be prescribed a sulfonylurea (37.8% vs. 23.5%, p=0.009) , and less likely to be prescribed insulin (42.3% vs. 54.2%, p=0.033) . There were no differences in sex, self-reported race/ethnicity, or the prevalence of coronary artery disease (22.4% vs. 24.1%, p=0.779) , heart failure (10.9% vs. 8.4%, p=0.575) , or chronic kidney disease (25.6% vs. 17.5%, p=0.099) in electronic and in-person consult patients. In-person consult patients had a higher hemoglobin A1c (9.3±1.7% vs. 8.8±2.0%, p=0.032) . Nearly all e-consult referrals asked for guidance on medication selection (96%) with a significant number requesting advice on newer medications (SGLT2i: 21%; GLP-1 RA: 27%) . Completed e-consults often provided guidance and education on use, cardiorenal benefits, and/or side effects of newer medications (SGLT2i: 28%; GLP-1 RA: 47%) . Conclusions: In-person and e-consult patients had similar baseline characteristics and cardiovascular comorbidities. E-consults were often used to inquire and to educate about newer diabetes medications. E-consults hold promise as a method to disseminate new endocrine knowledge. Disclosure C.A.Colling: None. J.H.Wasfy: Consultant; Pfizer Inc. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate. Funding NIH T32 DK007028

PD25-02 UTILIZATION OF ECONSULT AND CLINICAL INTEGRATION TO MAXIMIZE ACCESS TO UROLOGIC CARE IN THE SAFETY NET: OUTCOMES FROM THE LARGEST eCONSULT EXPERIENCE IN THE UNITED STATES

You have accessJournal of UrologyCME1 May 2022PD25-02 UTILIZATION OF ECONSULT AND CLINICAL INTEGRATION TO MAXIMIZE ACCESS TO UROLOGIC CARE IN THE SAFETY NET: OUTCOMES FROM THE LARGEST eCONSULT EXPERIENCE IN THE UNITED STATES Jonathan Bergman, Katherine Fero, Jamal Nabhani, Jeremy Blumberg, Kiran Gollapudi, Stanley Frencher, and Paul Giboney Jonathan BergmanJonathan Bergman More articles by this author , Katherine FeroKatherine Fero More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , Jeremy BlumbergJeremy Blumberg More articles by this author , Kiran GollapudiKiran Gollapudi More articles by this author , Stanley FrencherStanley Frencher More articles by this author , and Paul GiboneyPaul Giboney More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Access to timely urologic care is a particular challenge in Safety Net systems with limited resources, challenging our ability to provide quality care for underserved and historically disadvantaged populations. In an effort to maximize urologic resources, the Los Angeles County Department of Health Services (LAC-DHS)—the second-largest public health care system in the United States—pursued clinical integration by instituting primary care empanelment, eConsult, and jointly derived Expected Practices, which are population-specific clinical algorithms for managing common urologic conditions. The eConsult platform allows forwarding of eConsults to other urologists throughout LAC-DHS to provide access to subspecialty resources (e.g., urodynamics) or to more timely surgical care. Our objective was to assess how eConsult, as part of a clinical integration effort, facilitated urologic care in the Safety Net. METHODS: We prospectively assessed eConsult use in LAC-DHS from January 2018 until October 2021. We measured eConsult volume, final clinical access (face-to-face visit versus a “non-face-to-face specialty-care touch [NFTFSCT],” resolved with input from a urologist but without a face-to-face urology visit), forwarding of consults for sub-specialty care or expedited access, reviewer response time, and proportion of patients seen within the intended time frame. We also assessed referral diagnosis as specified by the referring primary care provider. RESULTS: Of the 31,342 eConsults sent to urology, 28% were resolved with a NFTFSCT, while 72% necessitated a face-to-face visit. Forwarding of eConsults to another urologist for either subspecialty expertise or timeliness of care occurred in 8% of cases. Average response time was 1.8 days, and 91% of patients were seen within the intended time frame. The four most common diagnoses were lower urinary tract symptoms (20%), urolithiasis (20%), hematuria (18%), and urologic malignancy (16%). CONCLUSIONS: In the largest reported eConsult experience in the United States, clinical integration allowed eConsult to facilitate care and to ensure patients were seen at the right time, in the right location, by the right provider. Not only was access to urology clinic excellent, urologists extended care through NFTFSCT and by collaboratively building population-specific Expected Practices. When used as part of a clinically integrated system, eConsult maximizes urologists’ ability to care for large populations of individuals. Source of Funding: LAC-DHS © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e421 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Bergman More articles by this author Katherine Fero More articles by this author Jamal Nabhani More articles by this author Jeremy Blumberg More articles by this author Kiran Gollapudi More articles by this author Stanley Frencher More articles by this author Paul Giboney More articles by this author Expand All Advertisement PDF DownloadLoading ...

Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England

ObjectivesWe explored use and usability of general practitioner (GP) online services.SettingDevon and Cornwall, England.DesignMixed-methods sequential study based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment...

Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System.

Electronic consultations (e-consults) may be a valuable tool in the current era of increased demand for hematologists. Despite the increasing use of e-consults in hematology, their optimal utilization and impact on patient outcomes and workload are largely unknown. In this retrospective cohort study, we studied the hematology consult experience at Veterans Affairs Connecticut from 2006 to 2018. We included 7,664 hematology consults (3,240 e-consults and 4,424 face-to-face [FTF] consults) requested by 1,089 unique clinicians. We found that e-consults were rapidly adopted and used equally among physicians of different degrees of experience. The number of FTF consults did not decrease after the introduction of e-consult services. E-consults were preferentially used for milder laboratory abnormalities that had been less likely to result in a consult before their availability. Referring clinicians used e-consults preferentially for periprocedural management, anemia, leukopenia, and anticoagulation questions. Eighty-three percent of e-consults were resolved without needing an FTF visit in the year after the consult. Consults for pancytopenia, gammopathy, leukocytosis, and for patients with known malignancy were less likely to be resolved by e-consult. Among patients who were diagnosed with a new hematologic malignancy after their consult, having an e-consult before an FTF visit did not adversely affect survival. In summary, e-consults safely expanded delivery of hematology services in our health care system but increased total consult volume. We report novel data on what types of consults may be best suited to the electronic modality, the impact of e-consults on workload, and their optimal use and implementation.

P.216 Improving access to neurosurgeons through an electronic consultation service

Background: Timely access to neurosurgeons for clinical advice is limited depending on region and other social factors. An eConsult service providing access to neurosurgeons in Ontario, Canada may influence primary care provider (PCP) course of action and referral behaviours. Methods: The Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to neurosurgeons by PCPs between Jan 1, 2017 and Dec 31, 2018. Usage data and PCP responses to a mandatory closeout survey were analyzed. Results: A total of 432 eConsults were submitted. Specialist median response time was 2.29 days with 86.8% of responses occurring within 7 days. PCPs received a new or additional course of action in 53% of cases. An unnecessary face-to-face referral was avoided in 57% of all eConsults, and 50% of cases where the PCP initially contemplated requesting a referral. Over 86% of cases were rated at least 4 out of 5 in value for PCPs and their patients. Conclusions: The use of eConsult improves access to neurosurgeons by providing timely, highly-rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits.

PD03-07 EVALUATING MEDICAID UROLOGIC REFERRAL PATTERNS VIA ECONSULT IN A DIVERSE NON-INTEGRATED NETWORK OF COMMUNITY-BASED HEALTH SYSTEMS

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (PD03)1 Sep 2021PD03-07 EVALUATING MEDICAID UROLOGIC REFERRAL PATTERNS VIA ECONSULT IN A DIVERSE NON-INTEGRATED NETWORK OF COMMUNITY-BASED HEALTH SYSTEMS Desiree Sanchez, Alvin Kwong, Waheed Baqai, Sajid Ahmed, and Stanley Frencher Desiree SanchezDesiree Sanchez More articles by this author , Alvin KwongAlvin Kwong More articles by this author , Waheed BaqaiWaheed Baqai More articles by this author , Sajid AhmedSajid Ahmed More articles by this author , and Stanley FrencherStanley Frencher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001967.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most patients in the US receive urologic care in their local communities; yet, the majority of published urologic patient data is derived from academic/academic-affiliated centers or large registries. This is problematic given the lack of racially diverse and underserved populations within academic cohorts, and inability to access granular data within registries. Telemedicine services like electronic consultation (eConsult), an electronic, asynchronous provider-specialist consultation system, are now used across various health systems including California’s largest Medicaid network, the Inland Empire Health Plan (IEHP). The IEHP mandates eConsult use for all specialty referrals for its 1.2 million patients. Here, we present the largest analysis of eConsult use in urology and characterize referral patterns in the safety net from a diverse non-integrated network of community-based health systems across Southern California communities. METHODS: We retrospectively reviewed all patients referred via eConsult from 2018-2020. Our main objective was to perform a descriptive analysis of all urologic eConsults within the IEHP since inception of the program. We categorized consult type etiology and measured the final eConsult outcome recommendation (e.g., face-to-face referral, no further action etc). To assess efficiency we measured message count, urologist response time and time to eConsult close. RESULTS: From 5/2018-8/2020, 1205 patients were referred for urologic eConsult. Median age was 53 (IQR 39, 61). Most patients were male (60%). BPH and/or LUTS or Retention and Gender-confirming surgery were the most and least common referral types, respectively (Figure 1). Majority of eConsults resulted in face-to-face recommendation (75%). Median total message count was 2 (IQR 2,3). Urologists responded within 0.4 days (IQR 0.1, 1.2) and spent <5 min to complete an eConsult; eConsults were closed in <1.5 days (IQR 0.3, 8.1). CONCLUSIONS: We report the largest analysis of eConsult use in urology. Its use allows for timely, efficient urologic access in the IEHP and presents a means to assess urologic needs in the community. We had a high rate of in-person conversion suggesting the need to study eConsult implementation and optimization strategies. Source of Funding: HH Lee Research Grant. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e45-e45 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Desiree Sanchez More articles by this author Alvin Kwong More articles by this author Waheed Baqai More articles by this author Sajid Ahmed More articles by this author Stanley Frencher More articles by this author Expand All Advertisement Loading ...

Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study.

Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination. The objective of this study was to understand primary care providers' and specialists' perspectives on how e-consults affect communication and relationships between clinicians. Qualitative study using thematic analysis of semistructured interviews. Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited. Participants' perspectives on the role and impact of e-consults on communication and relationships between clinicians. Clinicians identified 3 types of e-consults' social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building. Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.

E-consult®, application d’e-santé pour mieux informer les patientes en consultation de chirurgie pour cancer du sein

IntroductionThe use of new information and communication technologies is one way of better informing the patient. E-health includes telemedicine but also patient information and self-monitoring, or continuous remote monitoring with connected objects and mobile apps. It is in this context that we have developed and designed a digital application, e-consult®, which we use at the François Baclesse center, dedicated to improving information for patients. The objective of this study was to assess the performance of the e-consult® application in current practice, in order to know if the information delivered to patients was better retained with the application. MethodsWe conducted a prospective, single-center study at the Cancer Center François Baclesse. One group was received in consultation with the use of e-consult®, the other without. Following the consultation, the patient was given a questionnaire concerning her illness and a satisfaction questionnaire concerning the application. ResultsThe average score obtained on the questionnaire in the group having benefited from a consultation with e-consult® (7.12/10) was significantly higher than that obtained in the group having benefited from a consultation without e-consult® (6.4/10) (P=0.0276). ConclusionOur study showed that patients understood better the information transmitted in consultation with the use of e-consult®. In our opinion, this is the only study evaluating an application in consultation. However, our study has several weaknesses, including the lack of randomization, a small number of patient, and unvalidated questionaries. Despite these promising results, more studies with better internal validity are needed. Future research may also study the impact of the application on the doctor-patient relationship.

Evaluation of the Effects of the COVID-19 Pandemic on Electronic Consultation Use in Primary Care.

Background: Little is known about electronic consultation (e-consult) utilization during the COVID-19 pandemic when health systems rapidly implemented and scaled telehealth alternatives to in-person care. It is also unknown if e-consult utilization during the pandemic replaced or merely deferred the need for a specialty appointment. We evaluated if primary care providers' (PCPs) e-consult utilization and specialists' recommendations for specialty appointments changed after the transition to telemedicine during the COVID-19 pandemic. Methods: This cohort study used an interrupted time series analysis of e-consult utilization in a large, urban academic health care system between December 1, 2019, and June 27, 2020; the post-telemedicine time period began March 15, 2020. The primary outcome measure was the odds of an e-consult ordered during a PCP appointment; the secondary outcome measure was the odds of a specialist recommending a specialty appointment in an e-consult. Results: During 193,263 PCP appointments, 1,318 e-consults were placed to internal medicine subspecialties. Compared to the pre-telemedicine time period, the odds of a PCP ordering an e-consult increased (OR 1.04, 95% CI [1.02-1.07]) and the odds of specialists recommending specialty appointments increased (OR 1.11, 95% CI [1.06-1.15]). Conclusions: E-consult use increased following the transition to telemedicine in the context of the COVID-19 pandemic, suggesting that PCPs consider the e-consult a valuable tool for patient care when there is limited availability of specialty appointments. However, recommendations for specialty appointments following an e-consult also increased, suggesting that the e-consult may not replace the need for a specialty appointment.

Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy

ObjectiveElectronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but sparse data exist on the resultant quality of care for specific conditions. We examined workups resulting in a thyroid nodule fine-needle aspiration (FNA) biopsy to investigate whether endocrinology e-consults were more timely and similarly guideline-concordant compared with endocrinology face-to-face visits and whether endocrinology e-consults were more guideline-concordant compared with workups without endocrinology input. MethodsWe retrospectively reviewed charts of 302 thyroid FNA biopsies conducted in the Veterans Affairs health system between May 1, 2017, and February 4, 2020 (e-consult, n = 99; face-to-face visit, n = 100; no endocrinology input, n = 103). We used t tests to compare timeliness, χ2 tests to compare the proportion of guideline-concordant workups, and multivariable linear and logistic models to control for demographic factors. ResultsFNAs preceded by an endocrinology e-consult had more timely workups compared with those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy (geometric mean 44.7 days vs 61.7 days, P = .01). The difference in the summary measure of guideline concordance across groups was not statistically significant (P =.38). ConclusionE-consults were faster than face-to-face consults and similarly guideline-concordant compared with both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about the appropriate use of e-consults for thyroid nodules should take into account these data while also considering the potential benefits of direct patient-endocrinologist interaction for complex situations.

Impact of Pediatric Electronic Consultations in a Federally Qualified Health Center.

Background: Access to pediatric specialty care is a challenge, particularly for medically underserved populations. Introduction: One evolving method that has shown promise in helping ameliorate this disparity is electronic consultations (e-consults). Materials and Methods: This retrospective cohort study compared two groups: patients referred to pediatric cardiology, endocrinology, or pulmonology from a Federally-Qualified Health Center 10 months before the implementation of an evidence-based care pathway and those referred in the 10 months after implementation. The care pathway included evidence-based referral guidelines for common pediatric diagnoses and an e-consult process. Data included patient demographics, dates of referral requests, appointment dates, e-consult response dates and times, diagnosis codes, and consultants' recommendations. Results: Twenty-three percent of all referrals made postimplementation were submitted for an e-consult, with 53% preventing an unnecessary face-to-face visit. The most common reason for an e-consult was heart murmur/chest pain for cardiology, short stature for endocrinology, and asthma for pulmonology. Discussion: Providers used e-consults for nearly one-quarter of all consultations postimplementation, resulting in 17% of consultations not needing a face-to-face visit. The use of e-consults combined with evidence-based referral guidelines provided a useful tool to help front line pediatric primary care providers manage complex problems and identify those not needing to see a specialist in person. Conclusions: Evidence-based care pathways combined with e-consults can help improve access to pediatric specialty care by reducing demand for in-person visits and allowing more care to be delivered in primary care.