Congratulations to Vimalananda et al1 for their recently published systematic review of electronic consultations (e-consults). The authors did an excellent job of summarizing the existing literature and identifying key gaps. Based on our experience with e-consults that was published in May 2019, I wanted to add a couple of thoughts on areas that need further study.
We conducted a single-center investigation in our Veterans Health System that demonstrated a substantial reduction in wait times for our face-to-face clinic.2 One of the key issues we faced with implementation was identifying who would conduct the e-consults. Throughout multiple phases of testing, we found the best solution for us was to have a core group of 2-3 physicians. E-consults conducted by this smaller group were more effective and consistent than were e-consults done by a larger group of physicians and by our nurse practitioners or physician assistants. While not formally measured, we also anecdotally noticed some concerning trends in our referring clinicians’ behavior. Secondary consults would sometimes follow the e-consult, making the e-consult an ineffective encounter. We also observed an increase in total consult volume, possibly suggesting that the availability of e-consults increased demand that may have offset efficiencies in the program.
We agree that more rigorous investigation of e-consults is warranted to best understand how to incorporate them into clinical practice for Veterans and the general public.
FUNDING
DEW is supported by Career Development Award #13-023 from the U.S. Department of Veterans Affairs Health Services Research and Development Service. The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.
AUTHOR CONTRIBUTIONS
DEW is solely responsible for the content of this letter.
CONFLICT OF INTEREST STATEMENT
None declared.
REFERENCES
- 1. Vimalananda VG, Orlander JD, Afable MK, et al. Electronic consultations (E-consults) and their outcomes: a systematic review. J Am Med Inform Assoc 2020; 27 (3): 471–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Winchester DE, Wokhlu A, Vilaro J, et al. Electronic consults for improving specialty care access for veterans. Am J Manag Care 2019; 25 (5): 250–3. [PubMed] [Google Scholar]