Varied uptake in e-consults at New England VA facilities: Health Affairs
- A review of e-consult use across anesthesiology departments in the Veterans Affairs New England Health System finds widely varying uptake depending on perceptions of its value.
- The researchers looked at use of anesthesiology e-consults for preoperative evaluation at four VA facilities. Uptake ranged from nearly 100% to use for a limited number of low-risk patients to no use, according to the study published in Health Affairs.
- Sites with high e-consult use noted increased workflow efficiencies, while low- or no-use sites put a high value on in-person visits.
Clinicians' perception of a new technology has a big impact on how quickly it is adopted and disseminated throughout an organization. From that standpoint, e-consults should have a natural edge, the researchers note. They are viewed as beneficial, simple to use, can be tested before adoption and have measurable impacts on workflow.
Lack of rigorous outcomes data could account for some of the varying perceptions regarding the benefits of preoperative e-consults, the study says. At the same time, there were no obvious negative effects.
“Our data on preventable OR cancellation rates over a period before and after the implementation of e-consults showed stable-to-reduced rates,” the researchers write. “While we cannot directly attribute the decrease in these cancellations to the e-consult process, we are at least confident that the use of e-consults did not increase their rate.”
They call for more research on the impact of e-consults on overall efficiency and on medical outcomes.
More healthcare organizations are adopting bundled payments and population-based strategies that support value-based care. The VA has increasingly embraced virtual encounters in its effort to expand access to care. In 2016, the agency added new telemental health centers in South Carolina, Utah, Pennsylvania, Idaho, Washington and Oregon. And last August, it announced three telehealth and mobile application initiatives that allow veterans to get care at home — an initiative aimed at increasing access in rural areas.