Keeping care connected: e-Consultation program improves access to nephrology care

Priscille Schettini · Kevin P. Shah · Colin O’Leary · Malhar P. Patel · John Anderson · Alex H. Cho +3 more

32 citations0/0 files storedJournal of Telemedicine and Telecare

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Healthcare Systems and Technology Electronic Health Records Systems Telemedicine and Telehealth Implementation

Abstract

INTRODUCTION: Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. METHODS: We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. RESULTS: For traditional nephrology referrals placed during the study period (July 2016-March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. DISCUSSION: Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.

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2008Coordinating Care — A Perilous Journey through the Health Care System 2015Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis 2011Dropping the Baton: Specialty Referrals in the United States 2012Trends in Physician Referrals in the United States, 1999-2009 2013Utilization, Benefits, and Impact of an e-Consultation Service Across Diverse Specialties and Primary Care Providers 2013eReferral — A New Model for Integrated Care 2008A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease 2009Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

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