eConsult bolsters specialist access, but barriers remain, JAMA study says
A new JAMA report finds that eConsult can significantly improve access to specialists and reduce specialty work for primary care physicians.
The study found that eConsult can also, however, create “new challenges for clinicians to manage,” including increased administrative burden, added clinical responsibility and restructured specialty care delivery.
The study authors gauged the effects on patient care, workflow, specialty access and how eConsult affected PCPs in safety-net health systems in Los Angeles County.
More safety-net health systems are implementing eConsult systems. These web-based programs let PCPs work collaboratively with specialists at a remote location. PCPs submit all requests for specialty assistance electronically. It is then reviewed and discussed with specialists.
The idea is to improve patient access to specialists in safety-net hospitals while also improving care coordination, lowering PCP burden and offering specialist care in lower-cost settings.
The study interviewed 40 primary care physicians. “Many PCPs praised the improved timeliness of specialist input with eConsult, as well as the added clinical and educational value of dialogue with specialists, particularly compared with the limitations of the prior referral process,” according to the report.
However, similar to any change in care processes, changing over to eConsult can cause some challenges. “Delivery transformations can create new barriers as they solve existing problems,” according to the JAMA report.
PCPs were pleased with eConsult’s benefits, such as timeliness of care and the ability to manage specialty conditions. The issue of whether eConsult improved PCP workflow was mixed. That's consistent with many EHR efforts. Some doctors says more electronic forms and computer usage reduces the time they have to spend with patients without substantially improving care.
The JAMA report said successes and problems found in eConsult will likely be part of future primary care transformation efforts.
A 2017 New England Journal of Medicine case study at NYC Health + Hospitals found that successful eConsult programs need improved communication and information flow between PCPs and specialists.
For eConsult success, the NEJM report said, stakeholders need to shift expectations and improve communications. Specialists sometimes may feel short-term increased workloads. Also, eConsult can lead to workflow shifts, such as more scheduling moving from primary care to specialists, which may mean shifts in dedicated staff, according to the NEJM case study.
- JAMA Primary Care Practitioners’ Perceptions of Electronic Consult Systems
- New England Journal of Medicine Improving Access to Specialist Expertise via eConsult in a Safety-Net Health System