Are E-Consults the Future of Health Care?

More health-care workplaces are experimenting with electronic consultation, or e-consult, services, which may save time and money for patients and providers.

e-Consults allow primary-care providers to send cases to specialists for review through a secure electronic system, rather than referring a patient for an in-person visit. By reducing the number of visits to specialists, this system could alleviate some of the burden on overloaded health systems and save patients from unnecessary travel.

As reported in The New York Times, several large health-care systems in the U.S. already have adopted e-consultation, with more coming on board. In 2005, the San Francisco Department of Public Health established an e-consult program. After the program was implemented, patients’ wait times fell and health-care providers reported high levels of satisfaction.

The Los Angeles County Department of Health Services also began using e-consults in 2012. Again, wait times for specialist visits decreased by 17 percent, and one-quarter of consults were resolved without a patient visit. However, this experience highlighted persistent concerns with the program, such as primary-care providers reporting that e-consults shifted work and administrative burden from specialists to them. Health-care systems also may be hesitant to engage in e-consulting because of the costs of implementation, including hiring someone to manage and respond to inquiries.

Some studies also have identified a potential downside to e-consulting: increased volume of patients. A greater influx of patients could contribute to increases in health-care spending, and it is unclear if greater spending will translate to better health.

This approach is being explored in the management of hematologic disorders, as reported in a recent Blood article and covered in ASH Clinical News. Researchers, led by Ashok Pai, MD, from Kaiser Permanente Oakland Medical Center in California, developed a virtual benign hematology consultative service through which practitioners electronically submitted non-urgent benign hematology consultation requests through an e-consult portal.

The e-consult program, which allowed a hematologist to triage consults and included established order sets for the workup of common hematologic issues, reduced the time it took a specialist to examine patient charts and improved access to care for individuals in remote areas.

Source: The New York Times, March 18, 2019.