Electronic consults, or “eConsults” are exchanges between providers in the electronic medical record that allow referring clinicians, often in primary care, to obtain timely specialist input without the need for a separate face-to-face visit. This solution has shown promise in reducing wait times and unnecessary referrals and aligns with the incentivization of health systems by government and commercial payors to improve access and quality of care while reducing cost.
Yale’s population health team implemented and evaluated a large-scale eConsult program, and authored a September 2024 publication in PLOS One detailing the process. Using a multi-method approach, the researchers collected qualitative and quantitative data to assess operational outcomes on the implementation of the program and provider satisfaction among referring and specialist providers.
In 2016, a small-scale pilot eConsult program between six specialties and one Federally Qualified Health Center (FQHC) in New Haven, Connecticut established feasibility and acceptability. Engagement with the Association of American Medical Colleges (AAMC) Project Coordinating Optimal Referral Experiences (CORE) provided support in expanding the program to additional clinical sites and specialties.
As of January 2024, eConsults are available across 19 adult and 15 pediatric specialties. At the time of the publication, a total of 10,706 eConsults had been requested, of which 9,380 have been completed, 732 had been converted to face-to-face clinic visits, and 594 had been declined by specialists. The average response time is one business day, with the majority of consults (53%) requiring 10 minutes or less of specialist time. Ninety-two percent of primary care physicians reported satisfaction with the program and most found the specialist guidance provided in the eConsult to be helpful. Importantly, 61% of the completed eConsults originated from federally qualified health centers.
As noted by first author, Anita Arora, MD, MBA, MHS, associate professor of medicine and associate chief population health officer at Yale Medicine, “Engagement with a national eConsult learning collaborative led by the AAMC, leadership support, clinical champions, and strong partners in Information Technology and Data Analytics helped to create a robust eConsult program, with high satisfaction among both referring and specialty clinicians. We hope lessons learned at Yale may serve as a guide for other sites in their design and implementation of eConsult programs.”
Other study authors included Renee Fekieta, PhD, MA; Erica Spatz, MD, MHS; Brita Roy, MD, MPH, MHS; Karla Marco; Mona Sharifi, MD, MPH; Dinesh Pashankar, MD, MBA; and Babar Khokhar, MD, MBA.
Read more in “Implementation and evaluation of an electronic consult program at a large academic health system” published in PLoS One.
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