eConsult system boosts access to specialty care for underserved
The Los Angeles County Department of Health Services has implemented a system that connects primary care providers electronically to specialists, significantly reducing the times that low-income patients wait to receive specialty care while increasing access.
The lack of timely access to specialty care is a significant problem among low-income patients, according to Michael Barnett, MD, a primary care physician and assistant professor of health policy and management at Harvard T.H. Chan School of Public Health.
However, by using a web-based platform like the eConsult system leveraged by L.A. County DHS, Barnett contends that other departments of health around the country with similar resource limitations could improve access to specialists for underserved populations.
In 2012, L.A. County rolled out its eConsult system, which replaced the previous inefficient process of phone calls, emails and faxes, which often left patients waiting months for face-to-face appointments. By 2015, the electronic system was being used by more than 3,000 primary care providers, with more than 12,000 consultations conducted monthly versus just 86 in the third quarter of 2012.
The technology “helps to take medical care out of the face-to-face visit,” Barnett says, enabling primary care providers to request assistance from specialists via the platform with rapid specialist review and triage to determine which referrals should be seen in person or in another setting. All specialty referrals at L.A. County DHS go through the eConsult process.
“One of the ripest opportunities for disruption in ambulatory care is trying to help deliver specialist expertise outside of face-to-face consults, which are really quite an inefficient way for specialists to use their time,” he adds. “What the eConsult system does is help to bring primary care doctors and specialists closer together in an electronic setting so that they can actually discuss the best way to manage those cases.”
Barnett and his colleagues conducted a study, published this month in the journal Health Affairs, which found that under the eConsult system, the median time for an electronic response from a specialist was one day, and 25 percent of eConsults were resolved without a specialist visit.
Further, the median wait time to see a specialist decreased 17.4 percent—from 63 to 52 days—while the percentage of appointments scheduled within 30 days of the initial request increased from 24 percent to 30.2 percent.
“Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable,” concludes the article. “eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients.”
At the same time, Barnett acknowledges that the lack of integration between eConsult systems and electronic health record system is “the No. 1 complaint we hear—that it is separate from the EHR.” He adds that currently at L.A. County DHS there isn’t an interface between the systems.
“More modern EHRs do have an eConsult capacity that is linked with an EHR. But, that is certainly No. 1 on the wish list for the primary care doctors that we talk to,” says Barnett. “From the DHS perspective, they wanted to simply use something off the shelf that they knew worked and try to adjust the specialty access crisis as soon as possible.”