From the 2024 HVPA National Conference
Lianela Negron MD (Johns Hopkins Hospital), Michele Manahan MD, William Reid Thompson MD
Background
Electronic consultations are an asynchronous form of telehealth. These are interprofessional communications between providers only, without direct patient interaction by the consultant, by using phone, video, or another HIPAA-compliant secure platform for two-way communication and secure patient record sharing. In a survey of community health center medical directors in 9 Medicaid expansion states and DC, nearly 60% reported difficulty obtaining new specialist visits and multiple access barriers. Pediatric subspecialists are also a particularly limited resource and concentrated in urban areas. Econsult programs appear to be feasible in a variety of settings, are flexible in their application, and facilitate timely specialty advice.
Objectives
The aim of this study is to describe the initial experience of an eConsult service in subspecialty care at a large American academic center. Specifically, we aimed to measure appropriateness, time to eConsult completion, clinical indication and consulting care provider credentials for all JHM eConsults from 11/1/2021-3/31/2024.
Methods
We performed a retrospective cross-sectional analysis from de-identified data of all eConsult orders placed between 11/1/2021 to 3/31/2024. The participating eConsult services include the following subspecialties: Adult Spine Surgery, Adult Diabetes Mellitus, Adult Neurology, Adult Rheumatology, Vascular Surgery, Genetics, Pharmacogenetics, Rheumatology, Dermatology, Pediatric Cardiology, Pediatric Gastroenterology and Pediatric Endocrinology. Data collected included demographic patient information, eConsult acceptance rate by subspecialty service, average eConsult turnaround time by subspecialty service, eConsult clinical condition by subspecialty service and the consulting care providers credentials by subspecialty service.
Results
1024 eConsult orders were placed during the interest period. Of those, 73.7% (755) were considered appropriate for eConsult by the responding subspecialist and thus generated an eConsult encounter. Of the eConsult encounters, the proportion by subspecialty included Dermatology 24% (179); Diabetes Mellitus 22% (167); Neurology 22% (164); Rheumatology 8% (57); Genetics 7% (49); Vascular surgery 5% (41); Pediatric Cardiology 4% (32); Pharmacogenetics 4% (30); Adult Spine Surgery 2% (17); Pediatric GI 2% (16), and Pediatric Endocrinology 0.4% (3). Average turnaround time was 2.9 days, with a range of 0.5 – 8.7 days. Of the eConsult encounters placed by provider type, physicians account for 50% (379), nurse practitioners 25% (187), resident 16% (120), physician assistant 6% (43), fellows 2% (19), Genetics counselor 1% (4) and Clinical pharmacist/podiatrist/other(3). In 73% (557) of all completed eConsult encounters, the order was placed by a primary care provider: Internal Medicine (51%, 379), Family Medicine (16%, 124) and Pediatrics (7%, 54).
Conclusions:
The majority of clinical eConsult questions are placed appropriately and turn into completed encounters. Turnover time is on average < 3 days. Most eConsults are placed by physicians and from primary care providers.
Clinical Implications:
E-Consultation has emerged as a potential tool for improved primary care provider and subspecialty provider communication. It has been posited that eConsults have the potential to result in higher value in-person visits, streamline communications across large hospital systems, lead to shorter wait times, establish better documentation between providers, and improve timely and efficient access to advanced care if needed.