Pediatric dermatology eConsults: Reduced wait times and dermatology office visits

Abstract

Background/Objectives: Store-and-forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center. Methods: In this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings. Results: One hundred eighty pediatric patients with 188 unrelated skin conditions ("cases") were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out-of-pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017). Conclusion: Pediatric dermatology eConsults reduce wait times for specialist care, triage cases for in-office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients. K E Y W O R D S eConsults, health care delivery, store-and-forward teledermatology | 805 Pediatric Dermatology SEIGER Et al.

Evaluation of electronic consults for outpatient pediatric patients with dermatologic complaints

“…The wide adoption of SAF teledermatology is reliant on reliable reimbursement from payors, 13 and insurance plans are more likely to support this care modality if its cost‐effectiveness is proved. A recently published model of cost‐benefit analysis for eConsults determined the breakeven point at slightly over 50% reduction in the number of subsequent in‐person dermatology appointments, when only considering the cost of the initial pediatrician visit, eConsult, and follow‐up in‐person dermatology evaluation 5 . In our study, teledermatologists were comfortable managing 71.9% of the cases with teledermatology alone, similar to 77% of cases managed with teledermatology alone in a study of SAF modality in adult patients 7 .…”

“…4 It has been shown to reduce appointment wait times, preventing unnecessary in-person dermatology and emergency room visits and to provide accurate diagnosis and treatment recommendations. [4][5][6][7][8][9][10][11][12][13][14] Before the COVID-19 pandemic, teledermatology was most frequently delivered through the store-and-forward modality (SAF). 15 With SAF, a dermatologist asynchronously reviews patient's still images and electronic health record (EHR) to provide remote clinical guidance, allowing for great efficiency and flexibility.…”

Asynchronous teledermatology in medical education: Lessons from the COVID-19 pandemic

“…Whereas ''virtual visits'' occur synchronously and require patient and provider coavailability, eConsults ( provider-toprovider) and eVisits ( provider-to-patient) use ''store-and-forward'' technology to allow specialist review at a separate time with greater efficiency (Table I). Asynchronous teledermatology holds promise to expand access to dermatologic care, 4 is a viable adjunct to in-person dermatology, 5 and in our experience, augments trainee education.…”

“…Unlike patients in the dermatology clinic who will continue with the specialist, eConsult patients most often follow-up with the referring provider, not dermatology. 4 Consequently, students learn to develop a prescriptive treatment plan understandable to the nonspecialist. Students focus on a broad differential to educate referring providers about stepwise management and different referral decisions based on a range of possible clinical responses.…”

Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System

“…Prior literature has found that a substantial fraction of referral requests can be resolved without a patient requiring a face-to-face visit following eConsult implementation, 8 , 9 , 10 , 11 , 12 , 13 and that a higher fraction of patients are able to have appointments scheduled successfully 11 , 13 following eConsult implementation. However, prior evidence on eConsult systems’ effects is largely limited in scope (eg, single-specialty clinic in a particular system), or focuses on eConsult programs that do not function as the default referral system for all specialty requests (eg, are optional) as implemented in NYC H+H and other safety-net health systems.…”