The use of eConsults and Enhanced Referrals has been steadily expanding across Yale Medicine, as more specialties come on board, the number of participating primary care providers grows, and more insurers begin covering eConsults.
eConsults enable primary care doctors to ask patient-specific questions of YM specialists through the electronic health record (Epic). In many cases, this process can save patients from the inconvenience and expense of unnecessary specialist referrals. At the same time, eConsults provide primary care doctors with the information needed to successfully manage their patients’ conditions.
Enhanced Referrals provide primary care doctors with supportive information and guidance when they seek to refer a patient to a specialist, and they provide the specialist with all relevant clinical information and test results before the patient arrives. This helps the primary care physician determine whether a referral is necessary, ensures that the patient gets referred to the right specialist and that the specialist has all the information they need, and promotes shared expectations and planning between the referring provider and specialist.
Until recently, clinicians at five primary care sites in New Haven have been using eConsults and Enhanced Referrals to ask questions and obtain information from YM specialists. In May, the student-run HAVEN Free Clinic became the sixth primary care practice to utilize the programs. In addition, several school-based clinics in New Haven began using eConsults in September.
The other participating primary care sites are Yale Health, Fair Haven Community Health Center, Yale Internal Medicine Associates, Yale York Street Primary Care Center, and Yale Saint Raphael Primary Care Center.
Growing Number of Specialties Available
Cardiology became the first Yale Medicine specialty to participate in eConsults when the program launched in June 2018. Neurology followed in October 2018. New departments/sections have come on board throughout 2019, including adult Endocrinology, Geriatrics, and Rheumatology. In addition, Pediatric Gastroenterology (GI) joined the eConsult program in June, and Pediatric Rheumatology and Nephrology will join the program on Sept. 30.
Coming soon: Adult GI and Sleep Medicine are scheduled to go live with eConsults in October. Before the end of the calendar year, the following additional specialties will begin participating in eConsults: Adult Psychiatry, Urology, and Nephrology, as well as Pediatric Endocrinology, Neurology, and Urology.
“We are on track to get all pediatric and adult specialties up and running with eConsults by mid-2020,” says YM Director of Population Health Brita Roy, MD, MPH.
All of the primary care sites and specialties that take part in the eConsult program also participate in Enhanced Referrals.
Utilization on the Rise
Utilization of eConsults and Enhanced Referrals has been growing as more specialties are added and as primary care providers and patients become familiar with the benefits of the programs, Dr. Roy says. Of the six participating primary care sites, Yale Health has been using eConsults the most.
Also contributing to the growing usage of eConsults is the fact that more and more insurers are now covering the service, Dr. Roy says. Medicare and Medicaid in Connecticut now pay for eConsults, as do the majority of Yale Medicine’s commercial payers.
In a recent survey, about 86% of participating primary care providers said they are highly satisfied with YM’s eConsult program. Seventy-five percent strongly agreed that an eConsult response had influenced their care plan.
“The programs have been very popular and well-received among primary care providers and specialists alike,” Dr. Roy says. “They have greatly improved efficiency of care for our patients as well as the quality of care we’re able to provide at Yale Medicine.”