E-consults hold promise for efficient PCP and specialist interaction

By Frank Irving
10:36 AM

A recent report published by The Commonwealth Fund finds that electronic consultation between primary care physicians and specialists could improve healthcare quality and reduce specialty care costs. However, e-consultation will be limited unless physicians can earn incentives and be reimbursed for use of the technology.

E-consults occur through e-mail or other applications such as shared electronic medical record (EMR) systems that include clinician-to-clinician messaging capabilities as well as Web-based electronic referral systems.

“Shared EMRs and electronic consultation systems provide a vehicle for referring and consulting clinicians to interact efficiently
by allowing referring clinicians to pose questions to consultants, and consultants to respond with or without seeing the patient,” wrote report co-authors Kathryn Horner, Ed Wagner and Jim Tufano.

The technology is appealing because computer communications can be asynchronous – busy physicians do not need to find a mutually convenient time to connect. E-consults can also facilitate the transfer of patient information and document physician interactions in the patient’s medical record.

Several physicians interviewed for the report noted that primary care doctors are less likely than in the past to provide care in hospital settings; therefore, they have fewer opportunities to interact face-to-face with specialists in what were commonly known as “curbside consults.” Electronic consults can help fill that void.

Reductions in specialist visits through the use of e-consultation range from 8.9 percent to 51 percent, with the majority of estimated reductions around 30 percent, the report stated. These reductions in avoidable specialist visits are a primary reason for net financial savings reported by some e-consultation system evaluations. At the Mayo Clinic, researchers extrapolated that if each provider ordered e-consults two to three times monthly, the system could avoid 1,800 specialty consultations per year, reducing direct costs by $450,000 annually.

According to the report authors, e-consults most likely to elicit an effective response from a specialist include a clear question, proposed task or intervention, and desired outcome.

At the same time, the potential of e-consultation varies by specialty. It’s most likely to be appropriate for specialists who provide cognitive advice rather than those who perform procedures. Specialties that rely heavily on laboratory tests and less on patient examination (e.g., endocrinology, nephrology) have the most potential to become heavy users of e-consultation. Because photographs of skin lesions can be attached to e-consultation requests, it may also offer strong potential for uses in dermatology, the authors reported. Gastroenterology, interventional cardiology, and other specialties that are based on performing procedures have the least potential for utilizing e-consultation.

In practice, specialists could schedule short appointment slots to review patients’ medical charts and provide e-consultations back to the primary care physicians. Additionally, organizations could capture incoming e-consultations for a specialist group in a shared pool; in such a setup, the group would either rotate responsibility for responding to
 requests or hold one specialist solely accountable for all e-consultations.

The report said health care payers and plans in fee-for-service payment systems could have
an impact on the dissemination and adoption of e-consultation models by reimbursing clinicians when they request or respond to e-consults. Policy could also play a role by including e-referral and e-consultation technologies and processes in Stage II and III meaningful-use objectives for under Medicare/Medicaid EHR incentive programs.


Frank Irving is editor of PhysBizTech, a multi-platform online publication covering business and technology issues for small and medium-sized practices. Click here to subscribe.

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