By Patrick Welch, MD
Implementing new technologies within any medical practice or health system can be daunting. But as technologies have appeared and demonstrated their value, providers have been at the forefront, forging paths toward implementation for the good of their patients. eConsults, a form of telehealth that enables primary care physicians to consult with specialists via secure online messaging platform, represent a promising technology for health care providers. However, barriers to implementation remain as providers wonder about the effects of eConsult implementation on their workflow and their ability to provide quality care.
It is approaching one year that my health care organization, CHC Central Coast, has been leveraging an eConsult platform. As a provider, I feel it’s important to look to the experiences of organizations and clinical leaders that have successfully implemented and realized the benefits of technologies such as eConsults.
Organizational challenges and goals
At CHC Central Coast, we face several challenges as a health organization. For example, as a federally qualified health center, access to specialists can sometimes be limited. Our rural clinics face barriers such as lack of transportation, or financial burdens. When patients don’t get the care they need, their health as well as confidence in their healthcare providers weakens. We are consistently challenged as an organization to most efficiently and effectively shepherd and manage resources to care for our patient population.
In light of these challenges, we had several goals when it came to eConsult implementation. First, we aimed to provide quick and reliable specialty access to all of our patients, especially those in rural areas who have more barriers to care than the average patient. And second, we wanted to provide opportunities for our providers to access higher level feedback from specialists in a timely manner in order to optimize quality of care at the clinical level.
The eConsult implementation process—expectations and results
When we decided to implement an eConsult system, my main expectation was for our providers to get reliable information back, and that the platform would not add extra time to our workflow. Indeed, as providers, the effect of eConsult implementation on our workflow was one of the chief concerns shared by me and my colleagues. Meanwhile, at the health system level, there was the challenge of cultural change, as an eConsult program represents a significant alteration to the way the system has been set up. How do you evolve the culture into a new age of medicine while ensuring that patients are getting the same quality of care, if not better? These were the challenges and expectations we had when we started this process.
When it came time to implement the eConsult system, everything was seamless. Our eConsult partner team was transparent and communicative; they set clear expectations in terms of timeframe and workflows, and they met those expectations. As for the system itself, the eConsult platform worked smoothly with our existing referral process. Our workflow, for the most part, was hardly impacted at all. We implemented a set of rules whereby referrals are assigned to AristaMD for triage of eConsult appropriateness. Eligible cases are submitted, while ineligible cases are sent for a face-to-face specialist appointment.
As for the more hesitant providers, the feedback on being able to speak directly to a specialist via the eConsult platform was immensely positive. Quick responses with the ability and willingness of specialists to have a discussion have made it easier for providers to give it a try and believe that the process actually works. They’ve become more accepting, overall, to the kind of change that eConsult implementation brought—change that we sorely needed.
eConsult implementation led to improvements in access, resource usage, and outcomes
Once implemented, I saw many benefits of eConsults, the clearest being vastly improved access to specialist care. With eConsults, you get immediate feedback from the specialist, and I get to see that value for patients in real time. eConsults also helped us use resources much more efficiently. Before eConsult implementation, whenever there was uncertainty in a treatment plan, I would need to order additional diagnostic tests. Instead, this can now often be handled via an eConsult, giving me confirmation or affirmation that the patient was being given the right treatment plan and freeing up diagnostic resources.
My fellow providers have also been happy with our eConsult system. I’ve heard many note that it saves patients unnecessary visits and time off work. Others remarked that they never realized eConsults could help them in that way—that some of the simple or less complicated questions don’t necessarily need a face-to-face referral and can instead be answered within a few hours via an eConsult. My colleagues were pleasantly surprised about how much they could expand their scope of knowledge through these platforms. eConsults have made everything more efficient and more accurate, increasing quality of care.
Finally, for all the challenges in getting more reluctant providers on board with eConsult implementation, patients were very accepting of this new technology. Most were quite open to not having to see another doctor or having to travel somewhere else. In addition, patients took comfort in knowing their PCP was engaged enough to ask for specialist input and to get a second opinion on their care. When they understood this type of specialty care support avoided an additional appointment to see a different provider, and that they’d receive the same high-quality care from within the primary care office, they were all for it.
As a practicing primary care physician, I’ve seen why timely access to quality specialists is a top priority. It is important that we continue to evolve our practices in order to provide quality medical care, in a timely manner, to our patients. eConsults provide quick access to specialists who provide clear evidence-based recommendations. My patients no longer need to wait weeks to months to receive the specialist feedback they need, helping me to be more confident that I’m helping patients as efficiently and as effectively as I can. eConsults have given me great optimism for the future of health systems, as we strive to use the best available resources to improve the health care delivery process for everyone.
Patrick Welch, MD is a physician of Family Medicine for CHC Central Coast.