Reports From the Field

An eConsults Program to Improve Patient Access to Specialty Care in an Academic Health System


 

References

We measured the impact of the eConsults program on access to care by the response time for eConsult requests and the percentage of eConsults that averted an in-office visit with a specialist. We found that the eConsults program at UCI provided our PCPs access to specialist consultations in a timely manner, with much shorter response times than standard in-person referrals. The average turnaround time for an eConsult response we reported is consistent with findings from other studies.12-15 Additionally, our program was able to address about 80% of its eConsults electronically, helping to reduce unnecessary in-person specialist referrals. In the literature, the percentage of eConsults that avoided an in-person specialist visit varies widely.8,12-16

We reported very positive feedback from both PCPs and specialists on UCI’s eConsults service. Similarly, other studies described PCP satisfaction with their respective eConsults programs to be uniformly high,8,9,13,14,17-19 though some reported that the level of satisfaction among specialists was more varied.18-21

Lessons Learned

The successful design and implementation of our eConsults program began with assembling the right clinical champions and technology partners for our steering committee. Establishing regular steering committee meetings helped maintain an appropriate timeline for completion of different aspects of the project. Engaging support from UCI’s leadership also provided us with a dedicated IT team that helped us with the build, training resources, troubleshooting issues, and reporting for the project.

Our experience with implementing the eConsults program on 2 different EHR systems highlighted the importance of creating efficient, user-friendly workflows to foster provider adoption and achieve sustainability. Allscripts’ open platform gave our IT team the ability to create a homegrown solution to implementing an eConsult model that was simple and easy to use. The Epic platform’s interoperability allowed us to leverage our learnings from the Allscripts build to efficiently implement eConsults in Epic.

We also found that providing modest incentive payments or reimbursements to both PCPs and specialists for each completed eConsult helps with both adoption and program sustainability. Initially, credit for the eConsult work was paid by internal UCI Health System funds. Two payers, UC Care (a preferred provider organization plan created just for the University of California) and more recently, the Centers for Medicare & Medicaid Services, have agreed to reimburse for outpatient eConsults. Securing additional payers for reimbursement of the eConsult service will not only ensure the program’s long-term sustainability, but also represents an acknowledgment of the value of eConsults in supporting access to care.

Applicability

Other health care settings that are experiencing issues with specialty care access can successfully implement their own eConsults program by employing strategies similar to those described in this report—assembling the right team, creating user-friendly workflows, and providing incentives. Our advice for successful implementation is to clearly communicate your goals to all involved, including primary care, specialists, leadership, and IT partners, and establish with these stakeholders the appropriate support and resources needed to facilitate the development of the program and overcome any barriers to adoption.

Pages

Recommended Reading

Strategy critical to surviving drug shortages
Journal of Clinical Outcomes Management
Storytelling tool can assist elderly in the ICU
Journal of Clinical Outcomes Management
Families as Care Partners: Implementing the Better Together Initiative Across a Large Health System
Journal of Clinical Outcomes Management
Developing a Real-Time Prediction Model for Medicine Service 30-Day Readmissions
Journal of Clinical Outcomes Management
Impact of Hospitalists on Care Outcomes in a Large Integrated Health System in British Columbia
Journal of Clinical Outcomes Management
Use of an Electronic Alert Tool to Prevent Readmissions Following Coronary Artery Bypass Graft Surgery
Journal of Clinical Outcomes Management
Remdesivir in Hospitalized Adults With Severe COVID-19: Lessons Learned From the First Randomized Trial
Journal of Clinical Outcomes Management
Atypical Features of COVID-19: A Literature Review
Journal of Clinical Outcomes Management
AHA offers advice on prehospital acute stroke triage amid COVID-19
Journal of Clinical Outcomes Management
Procalcitonin-Guided Antibiotic Discontinuation: An Antimicrobial Stewardship Initiative to Assist Providers
Journal of Clinical Outcomes Management