Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety‐Net Health Setting
Open accessAbstract
Objective: Health information technology (HIT) holds promise in increasing access to rheumatologists by improving the quality and efficiency of referrals, but few studies have examined its use for this purpose. We evaluated the use and impact of a novel electronic referral (eReferral) system in rheumatology in a safety‐net health system. Methods: We examined eReferrals over 4 years. Our primary outcome was use of preconsultation exchange, defined as back‐and‐forth communication between referring and specialty care providers, facilitating triage of referrals, requests for more information, or resolution of questions without a visit. We calculated the proportion of eReferrals that underwent preconsultation exchange, time to reviewer response, and number of visits scheduled. To increase generalizability, we selected a random sample of eReferrals to undergo additional blinded, adjudicated review to assess agreement on appropriateness for preconsultation exchange. Results: Between 2008 and 2012, 2,383 eReferrals were reviewed and 2,105 were eligible for analysis. One‐fourth of eReferrals were resolved without a clinic visit. The proportion of eReferrals undergoing preconsultation exchange increased over time (55% in 2008 versus 74% in 2011), and the volume of referrals also steadily increased over time. Reviewer response time averaged between 1 and 4 days. In the random sample of eReferrals that underwent adjudicated review, agreement between reviewers was high (κ = 0.72). Conclusion: HIT‐enabled preconsultation exchange was used for a majority of eReferrals and facilitated communication between referring clinicians and rheumatologists. This redesigned system of care allowed for triage of a high number of referrals, with many referrals determined to be appropriate for preconsultation exchange.
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The average/median time for PCPs to receive a response from specialists to eConsult requests ranged from <1 to <6 days.
“The average/median time for the PCPs to receive a response from the specialists to the eConsult requests ranged from <1 18,49,50 to <6 days.11,51”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [51]
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- Authors
- Scheibe, M. M., Imboden, J. B., Schmajuk, G., Margaretten, M., Graf, J. D., Chen, A. H., Yelin, E. H., & Yazdany, J.
- Affiliations
- University of Minnesota (US)
- University of California, San Francisco (US)
- San Francisco VA Medical Center (US)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2015-07-26
- Volume
- 67
- Issue
- 8
- Pages
- 1158-1163
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC4515392
- OpenAlex
- W1737639124
- Cited by
- 38
- References
- 11
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 1 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 3 · 2015: 2
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Rheumatology Research Foundation
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23 AR060259, P60 AR053308)
- Rosalind Russell Medical Research Center for Arthritis at the University of California, San Francisco
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- electronic referral system, rheumatology consultation, health information technology, safety-net health system, referral triage, referral appropriateness
- MeSH terms
- Female, Humans, Male, Medical Informatics, Middle Aged, Outcome and Process Assessment, Health Care, Referral and Consultation, Rheumatic Diseases, Rheumatology
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