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Cited by 53Healthcare Systems and TechnologyTelemedicine and Telehealth ImplementationElectronic Health Records Systems

Analysis of an electronic consultation program at an academic medical centre: Primary care provider questions, specialist responses, and primary care provider actions

Wrenn, Katherine, Catschegn, Sereina, Cruz, Marisa, Gleason, Nathaniel, Gonzales, Ralph·2017·Journal of Telemedicine and Telecare
DOI 10.1177/1357633x16633553
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Abstract

Introduction: Electronic consultations (eConsults) increase access to specialty care, but little is known about the types of questions primary care providers (PCPs) ask through eConsults, and how they respond to specialist recommendations. Methods: This is a retrospective descriptive analysis of the first 200 eConsults completed in the UCSF eConsult program. Participating PCPs were from eight adult primary care sites at the University of California, San Francisco (UCSF), USA. Medicine subspecialties participating were Cardiology, Endocrinology, Gastroenterology/hepatology, Hematology, Infectious diseases, Nephrology, Pulmonary medicine, Rheumatology, and Sleep medicine. We categorized eConsult questions into “diagnosis,” “treatment,” and/or “monitoring.” We performed medical record reviews to determine the percentage of specialist recommendations PCPs implemented, and the proportion of patients with a specialist visit in the same specialty as the eConsult, emergency department visit, or hospital admission during the subsequent six months. Results: PCP questions related to diagnosis in 71% of cases, treatment in 46%, and monitoring in 21%. Specialist responses related to diagnosis in 76% of cases, treatment in 64%, and monitoring in 40%. PCPs ordered 79% of all recommended laboratory tests, 86% of recommended imaging tests and procedures, 65% of recommended new medications, and 73% of recommended medication changes. In the six months after the eConsult, 14% of patients had a specialist visit within the UCSF system in the same specialty as the eConsult. Discussion: eConsults provide guidance to PCPs across the spectrum of patient care. PCPs implement specialists’ recommendations in the large majority of cases, and few patients subsequently require in-person specialty care related to the reason for the eConsult.

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  • Several services, including those at the VHA, VA, UCSF, and Mayo Clinic, use private networks where the eConsult service is embedded into an electronic health record shared by referring providers and specialists, enabling the specialist to directly access patient information.

    “Several services, including those at the VHA, 11,12 Veteran's Affairs (VA), [13][14][15] UCSF, 16,17 and the Mayo Clinic, 10,18,19 use private networks, where the eConsult service is embedded into an electronic health record shared by referring providers and specialists, enabling the specialist to directly access patient information.”

    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 [16]

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Authors
Wrenn, K., Catschegn, S., Cruz, M., Gleason, N., & Gonzales, R.
Affiliations
University of California, San Francisco (US)
Corresponding author
Gleason, Nathaniel
ORCID
Venue
Journal of Telemedicine and Telecare
Publisher
SAGE Publications
Published
2016-07-08
Volume
23
Issue
2
Pages
217-224
ISSN
  • 1357-633X (ISSN-L)
  • 1758-1109
DOI
10.1177/1357633x16633553
OpenAlex
W2310537914
Cited by
53
References
22
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 8 · 2021: 8 · 2020: 10 · 2019: 5 · 2018: 9 · 2017: 3 · 2016: 2
FWCI
12.27
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Telemedicine and Telecare (publishedVersion)
  • PubMed (publishedVersion)
Funders
University of California, San Francisco
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, primary care providers, academic medical centers, telemedicine
MeSH terms
Academic Medical Centers, Adolescent, Adult, Aged, Female, Humans, Male, Medicine, Middle Aged, Primary Health Care, Retrospective Studies, Remote Consultation, Young Adult, Physicians, Primary Care

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