Evaluating E-Consults in Primary Care to Improve Usability and Efficiency

Christina L. Chon, University of Vermont


Purpose: Patients in a rural state face challenges in accessing specialty healthcare providers including provider shortages, travel distance, cost, lack of insurance coverage and lack of internet access. Electronic consultations provide an opportunity to improve access to specialists without local specialty and subspecialty healthcare services. The usability and outcomes associated with the electronic consult workflow at a university-affiliated primary care clinic (average provider time to complete the consult, time to consultation, number of avoided specialty visits, type of consult and provider or patient satisfaction) was unknown. The aim of this project was to evaluate the process of e-consults in primary care to improve usability and process efficiency over a 12-month time frame.

Methods: The e-consult process flow was evaluated to understand the usability and outcomes associated with the clinic’s workflow. Education on the e-consult process was presented and providers were surveyed about facilitators for and barriers to the process.

Results: The number of e-consults increased over time (n=12) during the project time frame; 58% (n=7) of specialty consults were resolved electronically allowing patients to be co-managed without an additional patient visit to a specialty provider, and 75% (n=9) of primary care providers received a consultant response within 24 hours of the consult initiation. Providers surveyed agreed the process was efficient.

Conclusion: E-consults are an efficient tool to integrate specialty care with primary care and improve availability of specialty services in rural areas. Additionally, this process provides opportunities for primary care providers to collaboratively manage patients with specialists.