Electronic Consultations: Complexities and Promise
Authors: Varsha G. Vimalananda, B. Graeme Fincke
Journal: Annals of Internal Medicine (2020)

Editorials19 May 2020Electronic Consultations: Complexities and PromiseVarsha G. Vimalananda, MD, MPH and B. Graeme Fincke, MDVarsha G. Vimalananda, MD, MPHBedford VA Hospital, Bedford, and Boston University School of Medicine, Boston, Massachusetts (V.G.V.)Search for more papers by this author and B. Graeme Fincke, MDBedford VA Hospital, Bedford, and Boston University School of Public Health, Boston, Massachusetts (B.G.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1320 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Electronic consultations (e-consults) enable patients to benefit from specialist expertise without ever seeing the specialist and thus represent a revolution in delivery of outpatient health care. Referring clinicians submit questions about their patients within either a shared electronic health record or a secure web-based platform. After reviewing the questions and available relevant data, consulting specialists respond within a few hours or days. Referring clinicians are responsible for appropriate application of the specialists' recommendations to their patients. e-Consults often obviate the need for patients to travel to a face-to-face visit and thus make the benefits of specialty expertise more readily available ...References1. Barnett ML, Yee HF, Mehrotra A, et al. Los Angeles safety-net program eConsult system was rapidly adopted and decreased wait times to see specialists. Health Aff (Millwood). 2017;36:492-499. [PMID: 28264951] doi:10.1377/hlthaff.2016.1283 CrossrefMedlineGoogle Scholar2. Liddy C, Rowan MS, Afkham A, et al. Building access to specialist care through e-consultation. Open Med. 2013;7:e1-8. [PMID: 23687533] MedlineGoogle Scholar3. Vimalananda VG, Orlander JD, Afable MK, et al. Electronic consultations (e-consults) and their outcomes: a systematic review. J Am Med Inform Assoc. 2020;27:471-479. [PMID: 31621847] doi:10.1093/jamia/ocz185 CrossrefMedlineGoogle Scholar4. Gleason N, Prasad PA, Ackerman S, et al. Adoption and impact of an eConsult system in a fee-for-service setting. Healthc (Amst). 2017;5:40-45. [PMID: 27469441] doi:10.1016/j.hjdsi.2016.05.005 CrossrefMedlineGoogle Scholar5. Ahmed S, Kelly YP, Behera TR, et al. Utility, appropriateness, and content of electronic consultations across medical subspecialties. A cohort study. Ann Intern Med. 2020;172:641-7. doi:10.7326/M19-3852 LinkGoogle Scholar6. Scheibe MM, Imboden JB, Schmajuk G, et al. Efficiency gains for rheumatology consultation using a novel electronic referral system in a safety-net health setting. Arthritis Care Res (Hoboken). 2015;67:1158-63. [PMID: 25623810] doi:10.1002/acr.22559 CrossrefMedlineGoogle Scholar7. Pecina JL, North F. Early e-consultation face-to-face conversions. J Telemed Telecare. 2016;22:269-76. [PMID: 26395892] doi:10.1177/1357633X15602634 CrossrefMedlineGoogle Scholar8. Strymish J, Gupte G, Afable MK, et al. Electronic consultations (e-consults): advancing infectious disease care in a large Veterans Affairs healthcare system. Clin Infect Dis. 2017;64:1123-1125. [PMID: 28158475] doi:10.1093/cid/cix058 CrossrefMedlineGoogle Scholar9. Chen AH, Murphy EJ, Yee HF. eReferral—a new model for integrated care. N Engl J Med. 2013;368:2450-3. [PMID: 23802515] doi:10.1056/NEJMp1215594 CrossrefMedlineGoogle Scholar10. Liddy C, Moroz I, Mihan A, et al. A systematic review of asynchronous, provider-to-provider, electronic consultation services to improve access to specialty care available worldwide. Telemed J E Health. 2019;25:184-198. [PMID: 29927711] doi:10.1089/tmj.2018.0005 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Bedford VA Hospital, Bedford, and Boston University School of Medicine, Boston, Massachusetts (V.G.V.)Bedford VA Hospital, Bedford, and Boston University School of Public Health, Boston, Massachusetts (B.G.F.)Disclaimer: The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1320.Corresponding Author: Varsha G. Vimalananda, MD, MPH, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Hospital, 200 Springs Road, Bedford, MA 01730; e-mail, Varsha.[email protected]gov.Current Author Addresses: Drs. Vimalananda and Fincke: Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Hospital, 200 Springs Road, Bedford, MA 01730.This article was published at Annals.org on 14 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUtility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties Salman Ahmed , Yvelynne P. Kelly , Tapas R. Behera , Michelle H. Zelen , Ifedayo Kuye , Ryan Blakey , Susan A. Goldstein , Jason H. Wasfy , Alistair Erskine , Adam Licurse , and Mallika L. Mendu Metrics Cited byImpact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care SystemSocial Media in the Times of COVID-19 19 May 2020Volume 172, Issue 10Page: 693-694KeywordsDermatologyHealth careHematology and oncologyInfectious diseasesMedicareMotivationOutpatientsQuality improvementRheumatologyTelemedicine ePublished: 14 April 2020 Issue Published: 19 May 2020 PDF downloadLoading ...