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Cited by 16Healthcare Systems and TechnologyElectronic Health Records SystemsTelemedicine and Telehealth Implementation

Implications of electronic consultations for clinician communication and relationships: a qualitative study

Open access
Anderson, Ekaterina, Vimalananda, Varsha G., Orlander, Jay D., Cutrona, Sarah L., Strymish, Judith L., Bokhour, Barbara G., Rinne, Seppo T.·2021·Medical Care
DOI 10.1097/mlr.0000000000001575PMC PMC8360667
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Abstract

Background: Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination. Objective: The objective of this study was to understand primary care providers’ and specialists’ perspectives on how e-consults affect communication and relationships between clinicians. Research Design: Qualitative study using thematic analysis of semistructured interviews. Subjects: Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited. Measures: Participants’ perspectives on the role and impact of e-consults on communication and relationships between clinicians. Results: Clinicians identified 3 types of e-consults’ social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building. Conclusions: Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.

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  • GI eConsults are an established model with substantial evidence supporting their accuracy and clinical utility.

    “In contrast, GI eConsults are an established model with substantial evidence supporting their accuracy and clinical utility.30”

    From Large Language Model–Generated Electronic Consultations: A Blinded Comparative Study of OpenEvidence and Gastroenterologist Electronic Consultations (2026) · cites this paper as [30]

    The Abstract says e-consults are increasingly used across health systems and facilitate access to specialty expertise, supporting the general point that they are an established, clinically useful model. The Results (Documentation of Communication) report clinicians’ perceptions of more reliable advice, but the paper does not establish the accuracy of GI eConsults or substantial GI-specific evidence for their clinical utility. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Anderson, E., Vimalananda, V. G., Orlander, J. D., Cutrona, S. L., Strymish, J. L., Bokhour, B. G., & Rinne, S. T.
Affiliations
  • University of Massachusetts Chan Medical School (US)
  • Boston University (US)
  • Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston
Corresponding author
  • Anderson, Ekaterina
  • Vimalananda, Varsha G.
  • Cutrona, Sarah L.
  • Bokhour, Barbara G.
  • Rinne, Seppo T.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-06-11
Volume
59
Issue
9
Pages
808-815
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/mlr.0000000000001575
PMC
PMC8360667
OpenAlex
W3166647823
Cited by
16
References
8
Citations by year
2026: 4 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 1
FWCI
2.18
Type
journal article
Language
en
Open access
Locations
  • Medical Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
U.S. Department of Veterans Affairs (IK2 HX002248)
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
e-consultation, provider communication, care coordination, primary care providers, specialists, legal liability, relationship building, veterans' health care
MeSH terms
Cardiologists, Neurologists, Attitude of Health Personnel, Communication, Health Personnel, Humans, New England, Primary Health Care, Specialization, United States, United States Department of Veterans Affairs, Remote Consultation, Qualitative Research, Electronic Health Records

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