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Electronic specialty triage consults reduce wait times, promote population health

by John W. Mitchell , Senior Correspondent
A program initiated less than five years ago is proving that it can enable faster specialty consults in underserved populations and could represent a disruptive driver for the health care delivery, according to a study just published in the March issue of Health Affairs.

The program, dubbed eSource by the Los Angeles County Department of Health Services, sets a protocol where all requests for a specialty consult from primary care physicians are reviewed by a specialist via email.

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"Use of eConsult in the Department of Health Services in LA was associated with a 17 percent decrease in median wait time and a one day turnaround from PCP eConsult to electronic specialist input," Michael Barnett, M.D., MS, lead author and assistant professor, Health Policy and Management, Harvard T.H. Chan School of Public Health, told HCB News.

Because the eSource consults were resolved without a face-to-face specialty visit, they also reduced costs. The results were achieved with no expansion of doctors in the specialty network.

eSource experienced rapid growth since its inception in the third quarter of 2012 when it registered 86 consultations. By 2015, more than 3,000 primary care providers received over 12,000 specialty consults a month.

"eConsult is more a different way of approaching specialty care than a technological innovation - it’s basically just email," said Barnett. "But the process of shifting a system to a re-consult model involves restructuring how specialty care is delivered, and that is disruptive."

Four years after its implementation, the median time for a covered patient to see a specialist decreased "significantly". Because volumes did not increase, the study implies a decreased wait time to see a specialist, according to the authors. Barnett also said the study found no evidence of pent-up demand for face-to-face specialty services.

"I’m excited about technologies that expand the capacity of physicians to provide care outside of a visit, like mobile telemedicine, internet enabled tele monitoring devices, and their potential integration into services like eConsult or other EHRs," said Barnett.

He noted that telemedicine efforts like eConsult can support population health by shifting specialty care from a visit-based, silo model to a system-based population-based effort. For example, he said when cardiologists are triaging consults for the whole health system electronically, it creates a centralized platform for management of cardiology problems across a population.

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