Table 4.

Illustrative Quotes by Construct and by High- and Low-Volume E-Consult Sites

Constructa	High-Volume	Low-Volume
Compatibility	“[E-consults are] very compatible. Before, I’d walk down and talk to the cardiologist, but it’s better for the flow of the day and location…it used to take 5 minutes to walk down there [to the specialist’s of- fice], but if you’re with a patient and need an answer that day, it takes patient care time away. I think [e- consults are] very good for the flow”	“If this is going to help the patients get taken care of, they are going to have to show it improving utilization and access. On the other hand if they start rejecting more consults and just [are] seeing them [patients] electronically, they are not necessarily go- ing to make the patients happier. We should define the criteria and expectations and see how this is going to impact the work flow”
Networks and communications	“I think there’s a better spirit of collegiality from e-consults, too. There could be a little bit of friction if there were too many consults, overworked, don’t have access. I find myself in a situation [now with e-consults] where the doc is actually looking for consults…I just find it better [for] communication and collegiality, I guess”	“Sometimes it seems when we send an e-consult it seems it goes out into space and no one looks at it; not sure how the process is on the other end. We have had to call and check sometimes because the specialist might have been gone. Would be nice to have some feedback if people are gone”
Training	“[We] provide training with CBOCs, other facilities. [At a] Regular scheduled time, [and] explain [the e- consult] process, and answer questions”	“There should be more training in terms of infor- mational conference calls. There has to be a rollout process if you want to do it widely. This hasn’t hap- pened so far. Secure messaging has had a formal rollout and we have a coordinator to manage, same thing for telehealth. Those are the ones funded that we have really been pushing this year, which hasn’t really happened with e-consult so far”
Access to knowledge and information	“I think a new person in the front office is a point person and was hired to keep it [e-consults] in the formal process” and “I’m the point person for pro- vider education, and we received approval for CME [continuing medical education] credits and a once- monthly educational program that will run through the year…[it’s] a phone-based conference providers can call into”	“Not sure who e-consult coordinator is now…Week or two ago, found out surgeons had no idea how to fill out e-consult to get credit. They are doing more than anyone…and getting no credit”

CBOCs indicates VA community-based outpatient clinics.

^aHigh-volume signifies Consolidated Framework for Implementation Research ratings closer to +2; low-volume, closer to −2.