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 In an e-consult, specialists review a patient's electronic medical
record through a secure portal and answer questions from primary
care doctors who seek their advice and opinion.
This system is intended to replace the informal "curbside" practice
of clinicians seeking medical opinions from specialists by walking
into their offices, or over the phone.
Informal consultations don't get documented in the medical record,
and furthermore, specialists may get very limited or nonspecific
information "and they're trying to use that to make a
recommendation," said study author Dr. Neelam Phadke from the
Massachusetts General Hospital in Boston, where the new study was
conducted.
Phadke's team analyzed roughly 300 allergy e-consults and found more
than one in four provided advice and education without the patient
needing to go for further diagnostic testing or to see a
subspecialist.
Half the time, allergists needed no more than 11 minutes to complete
an e-consult.
"That includes the amount of time the allergist took to read the
questions, to review the charts, to make their recommendations and
to send these recommendations back to the primary care doctor,"
Phadke told Reuters Health by phone. "There's no doubt that for all
of the people who are key players here, there is a significant time
saving."
The study also found that half the time, allergists were able to
respond to requests from other clinicians within 22 hours.
Traditional wait times are about a month for patients whose cases
have been flagged to allergists by primary care doctors that don't
use e-consults, because patients must then wait for an appointment
with the allergist.
Although the study was not designed to look at costs, previous
studies suggest nearly $125 is saved for every traditional new
patient consult replaced with an e-consult.
Still, e-consults are not yet popular among allergists.
One reason might be that e-consults are not currently recognized by
health insurers for reimbursement, Phadke said.
Dr. Tania Elliott, an allergist at NYU Langone Health in New York
City, who was not involved in the study, also noted that
administrative, operational and educational barriers need to be
addressed in order for e-consults to become mainstream.
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She agreed that e-consults can reduce unnecessary referrals and
diagnostic tests.
"There is particular potential to use them to treat drug allergy,
particularly penicillin allergy, and even skin allergies such as
atopic dermatitis and urticaria, if high resolution photos are
uploaded and sent to the allergist," she said.
Dr. Nathaniel Hare, an allergist at the UPMC Susquehanna Health
Allergy Clinic in Williamsport, Pennsylvania, believes e-consults
could become quite popular.
"I live in a relatively rural area in central Pennsylvania and take
care of patients that sometimes drive an hour or more to see me,"
Hare, who was not involved in the study, said. "There are times when
I am simply taking a history that could be done without them there
and then scheduling testing for a future date. I think having an
e-consult first could help address these sorts of issues."
For the study, researchers reviewed outcomes of 306 e-consults
performed between 2016 and 2018. They found that 60% of patients who
received an e-consult required an in-person consult to complete
diagnosis and management, while 13% of patients received exclusively
electronic guidance for diagnostic, therapeutic, or referral
recommendations that were followed nearly 75% of the time.
"The idea put forward in this study holds water only if you can do
e-consults (that can replace) an in-clinic visit ... in a fashion
that is cheaper and more efficient," Hare cautions.
"The closer I get to constructing a patient schedule that is 100%
full of patients who need to see me, the better use I am making of
my time and patients' time."
SOURCE: https://bit.ly/2NDnnBo Journal of Allergy and Clinical
Immunology: In Practice, online June 3, 2019.
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