Utilization, Benefits, and Impact of an e-consultation service across diverse specialties and primary care providers
Open accessAbstract
Background: Access to specialist advice remains a barrier for primary care providers (PCPs) and their patients. Virtual consultations have been used to expedite access. There are few studies demonstrating the utilization and impact of such services. We established a regional e-consultation service that was used across a wide range of specialty services and PCPs. Materials and Methods: We prospectively collected all e-consultations submitted from April 1, 2011 to June 30, 2012. Utilization data collected included number of e-consultations submitted, specialist response, and time required for the specialist to complete the e-consultation. Perceived benefit to the PCPs and their patients and the impact on care delivery were determined from a close-out survey. Results: Fifty-nine PCPs submitted 406 e-consultations to 16 specialty services. The specialist provided an answer without requesting further information in 89% of cases, with >90% of cases taking <15 min for the specialist to complete. Seventy-five percent of cases were answered in <3 days. The service was perceived as highly beneficial to providers and patients in>90% of cases. In 43% of submitted cases a traditional referral was originally contemplated but was now avoided. Conclusions: We successfully implemented an e-consultation service across diverse PCPs and specialty services that was highly valued. Almost half of referrals submitted would have required a face-to-face consultation if the service had not been available. Thus e-consultation has tremendous potential for improving access to specialist advice in a much more timely manner than the traditional referral–consultation process.
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eConsults can lead to decreased health care utilization and cost savings.
“eConsults can also lead to decreased health care utilization and cost savings.8,9”
From Large Language Model–Generated Electronic Consultations: A Blinded Comparative Study of OpenEvidence and Gastroenterologist Electronic Consultations (2026) · cites this paper as [9]
The Results report that a planned face-to-face referral was avoided in 43% of submitted cases, supporting the claim that eConsults can reduce specialist-service use. The paper does not report cost savings or a cost analysis, so that part of the claim is unsupported. (LLM, conf=0.88)
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- [1]1. Carriere G, Sanmartin C. Waiting time for medical specialist consultations in Canada, 2007. In: Health Reports . Catalogue No. 82-003-XPE. Ottawa: Statistics Canada, 2010; 21:1-8.
- [3]3. Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, Applebaum S. A survey of primary care doctors in ten countries show progress in use of health information technology, less in other areas. Health Aff (Millwood) 2012; 31:2805-2816.
- [7]7. Caffery LJ, Smith AC. A literature review of email-based telemedicine. In: Smith AC, Maeder AJ (eds). Global Telehealth . Amsterdam: IOS Press, 2010: 20-34.
- [8]8. Knol A, van den Akker TW, Damstra RJ, de Haan J. Teledermatology reduces the number of patient referrals to a dermatologist. J Telemed Telecare 2006; 12: 75-78.
- [9]9. Eminovic N, de Keizer NF, Wyatt JC, Riet G, Peek N, van weert HC, BruijnzeelKoomen CA, Bindels PJ. Teledermatologic consultation and reduction in referrals to dermatologists. A cluster randomized controlled trial. Arch Dermatol 2009; 145:558-564.
- [10]10. Stoves J, Connolly J, Cheung CK, Grange A, Rhodes P, O'Donoghue D, Wright J. Electronic consultations as an alternative to hospital referral for patients with chronic kidney disease: A novel application for networked electronic health records to improve the accessibility and efficiency of healthcare. Qual Saf Health Care 2010; 19:e54.
- [11]11. Rushakoff RJ, Woeber KA. Evaluation of a ''formal'' endocrinology curbside consultation service: Advice by means of the internet, fax, and telephone. Endocr Pract 2003; 9:124-127.
- [12]12. Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med 2010; 25:1123-1128.
- [13]13. Angstman KB, Robrer JE, Adamson SC, Chaudhry R. Impact of e-consults on return visits of primary care patients. Health Care Manage (Frederick) 2009; 28:253-257.
- [14]14. Abbott KC, Mann S, DeWitt D, Sales L, Kennedy S, Poropatich RK. Physician-tophysician consultation via electronic mail: The Walter Reed Army Medical Center Ask a Doc System. Milit Med 2002; 167:200-204.
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- Authors
- Keely, E., Liddy, C., & Afkham, A.
- Affiliations
- University of Ottawa (CA)
- Champlain Local Health Integration Network (CA)
- Corresponding author
- Keely, Erin
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2013-10
- Volume
- 19
- Issue
- 10
- Pages
- 733-738
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC3787335
- OpenAlex
- W1964743344
- Cited by
- 213
- References
- 0
- Citations by year
- 2026: 5 · 2025: 18 · 2024: 14 · 2023: 25 · 2022: 14 · 2021: 18 · 2020: 16 · 2019: 22 · 2018: 22 · 2017: 21 · 2016: 18 · 2015: 14 · 2014: 5 · 2013: 1
- FWCI
- 25.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Telemedicine Journal and e-Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Champlain Local Health Integration Network
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- e-consultation, telemedicine, primary care providers, specialist referral, access to specialist care, service utilization, perceived benefits, health care delivery
- MeSH terms
- Humans, Nurse Practitioners, Ontario, Primary Health Care, Prospective Studies, Specialization, Program Evaluation, Remote Consultation, Health Care Surveys, Physicians, Primary Care
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