Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

Abstract

BackgroundWe define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults.MethodsWe searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based.ResultsOur final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers.DiscussionE-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service

“…However, the literature on eConsult services in general is positive, with many studies citing improved access to specialist advice, better interprovider communication, and high levels of provider satisfaction. 16,17 These findings correspond with those for the Champlain BASE ™ eConsult service, both overall and specifically with regard to chronic pain cases. 14,19,32 Notably, PCPs have expressed high levels of satisfaction with cases submitted to chronic pain specialists.…”

“…16,17 To our knowledge, Champlain BASE ™ is the only service to have published studies examining eConsult's impact on chronic pain cases specifically. However, the literature on eConsult services in general is positive, with many studies citing improved access to specialist advice, better interprovider communication, and high levels of provider satisfaction.…”

“…14 The Champlain Building Access to Specialists through eConsultation (BASE ™ ) eConsult service began as a proof of concept in our region of eastern Ontario, Canada, offering access to 5 specialty services: dermatology, endocrinology, cardiology, rheumatology, and neurology. 15 Based on promising early results from our service and other eConsult services worldwide, 16,17 we expanded eConsult into a pilot in 2011, followed by a full service with provincial and regional funding in 2013. To date, the eConsult service has enrolled over 1200 PCPs and completed over 25,000 cases.…”

Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews (Preprint)

“…After removing duplicates and initial screening of titles and abstracts, 42 papers were retrieved for detailed evaluation. [24,25,26] which were part of another main study [6,27,28], leading to a total of 20 unique reviews [3,6,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. The overall process of review selection was …”

Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

“…15 Additional research is needed to assess potential cost savings and to fully evaluate the impact on practice workflow. 16,17 Prescreening through e-consult has been proposed to improve the efficiency and utility of in-person specialty care referrals. 18 Given the potential efficiencies, there have been calls to identify which clinical circumstances lend themselves well to asynchronous e-consult.…”