NYC Health & Hospitals system has developed and deployed an e-consult program that is both EHR linked and web-based. It has proved to be a very valuable tool that has cut wait time for speciality care appointments and improved the performance of PCPs in the health system (see: eConsult proves valuable tool for NYC Health+Hospitals in cutting wait times, speeding referrals). Below is an excerpt from it:
The [web-based, EHR integrated] eConsult tool allows primary care providers and specialists to communicate more effectively and co-manage patients when appropriate, as well as allowing them to connect patients to specialty care. The system is integrated through NYC Health + Hospitals' electronic health record systems, which helps with documentation. The eConsult system pilot began in August 2018 with two hospitals....September 2018 marked a milestone of 52,000 referrals reviewed and triaged thus far. The eConsult system helps streamline the referral process by allowing for rapid messaging and responses between providers when a primary care provider's patient has a health concern that would typically be treated by a specialist....Sometimes the communication is simply guidance that will allow the PCP to better treat the patient. Other times, when a specialist visit is necessary, the specialty clinic contacts the patient directly to schedule an appointment....NYC H+H said eConsult has helped to cut wait times for specialty care, showing that for patients referred for an in-person specialty care visit, the median wait time decreased from 50 days before eConsult to 28 days in June 2017.
Here's another link to a related article to the development of this e-consult software (see: Improving Access to Specialist Expertise via eConsult in a Safety-Net Health System) and below is an excerpt from it about the lessons learned in the process:
- Primary care providers consistently review eConsult responses and follow up with patients as needed.
- Specialty clinic staff schedule only those referrals that have been triaged appropriately.
- Specialists use the eConsult process as an opportunity for ongoing education for referring providers and for co-managing patients.
- Patients expect to be contacted by the specialty clinic if an appointment needs to be made.
There is a long history in the formerly paper-dominant healthcare world in which PCP referrals to medical specialists were largely a one-way street. This process was often inefficient and wasted resources. The e-consult software described helped to redress this imbalance and enabled a dialogue between the PCP and specialty personnel. As noted in the two quotes above, the software also provides guidance that allows PCP's to better treat patients and an opportunity for ongoing training in patient co-management. Because of an enhanced communication and training channel, median wait time for speciality appointments in the NYC Health & Hospitals system has almost halved since the final software deployment.