When Email Comes to the Doctor’s Office, Wait Times Decrease

The kind of thing we have done instinctively in our workplaces For two main decades — sending a quick email instead of setting up a meeting — has until recently eluded many doctors.

Electronic consultations, or eConsults (sometimes called eReferrals), are a growing way for primary care doctors along with specialists to communicate with each various other securely. They can help patients avoid additional visits to specialists along with free up capacity in crowded health systems, reducing waiting times for others.

Studies have found of which a large proportion of referrals to specialists — upward of 40 percent in some cases — are not needed.

Getting the right medical advice without another visit to a specialist might be especially helpful for patients on Medicaid or without insurance. One national study found of which nearly one-third of specialists are unwilling to make appointments with completely new Medicaid patients. Delays in getting the right advice via a specialist can cause harm. For patients who would certainly have to travel far to see specialists — those in rural areas, for example — eConsults can save considerable time, expense along with headaches.

Here’s how eConsults work. When a question arises of which your primary care doctor can’t answer without advice via a specialist — whether an M.R.I. for knee pain is actually warranted, for example, or how to interpret a test result — she messages a specialist reviewer for help. of which reviewer engages in an electronic dialogue with your doctor to gather information along with decide if the issue can be addressed without a separate visit. Often of which can be.

Some of the early eConsults adopters were the larger public health systems within the United States, including the Veterans Health Administration.

The first U.S. system to adopt one, in 2005, was the San Francisco Department of Public Health. Wait times fell, along having a large majority of primary care doctors said of which enhanced care.

“A safety net system can’t afford to hire enough specialists to meet demand — eConsults get around of which problem by increasing access through enhancing efficiency,” said Dr. Mitchell Katz, who was director of the San Francisco Department of Public Health when eConsults began there. He is actually right now the president of NYC Health & Hospitals, the nation’s largest public health care network, along with he wants to expand the use of eConsults there as well.

The Los Angeles County Department of Health Services, the second-largest public health care system within the nation, began using eConsults in 2012. A study in Health Affairs tracked waiting times for 12 types of specialists, including cardiology, gastroenterology, gynecology, ophthalmology, podiatry along with urology. Before the eConsult system, waiting times for some specialists extended months. For gastroenterology along with urology, one-quarter of patients waited over nine months for an appointment.

By 2015, three years after the Los Angeles County eConsults system was in place, waiting times for specialists had fallen by an average of 17 percent, to 52 days via 63 days. The proportion of appointments scheduled within 30 days rose to 30 percent via 24 percent. A quarter of eConsult engagements between primary care along with specialist physicians were resolved with no visit at all.

“Because they’re so busy, doctors have a hard time talking to one another,” said Dr. Michael Barnett, a co-author of the study along with an assistant professor of health policy along with management at the Harvard T.H. Chan School of Public Health. “EConsults resolve a lot of problems of which can be addressed with simple communication.”

Perhaps due to This particular reason, a vast majority of primary care doctors express high levels of satisfaction with eConsults, according to a systematic review of them published in 2015. Patients generally report Great experiences along with high satisfaction with eConsults, too, though one study found of which patients were equally satisfied with them versus in-person appointments.

Most studies report high satisfaction via specialists, nevertheless one found of which a large minority (26 percent) of them were dissatisfied. The concerns expressed included unclear clinical questions along with the possible liability associated with providing medical advice for patients they hadn’t examined.

In one study of the Mayo Clinic, a majority of primary care physicians said eConsults enhanced the quality of care. However, in another study of the Los Angeles County system, primary care doctors said eConsults shifted work along with administrative burden to them.

“Another concern is actually of which over time specialist reviewers might become less engaged along with route more patients to specialist visits to save time,” Dr. Barnett said. “If of which happens, the resource-saving benefits of eConsults would certainly fall.”

Despite these limitations, eConsults have also performed well in various other health systems. Randomized trials in a Veterans Health Administration hospital along with in a community health center found of which eConsults significantly sped up specialist input. A systematic review of eConsult systems within the United States — including at Kaiser Permanente along with the Mayo Clinic — along with abroad yielded similar results, nevertheless little evidence on enhanced outcomes.