The Benefits of eConsults: Literature Review

Electronic consults, or “eConsults” are asynchronous communications that empower primary care physicians with expert guidance and a present a platform for collaborative decision making. The latest research demonstrates compelling evidence that eConsults save time, cut costs, and improve patient outcomes. Ready to dive into the data? 

Here are five important research articles that reveal the powerful benefits of eConsults:

1. Impact of Primary and Specialty Care Integration via Asynchronous Communication

In this study, Geisinger Health System PCPs were provided with an asynchronous communication tool called Ask-a-Doc (AAD), facilitating direct communication with specialists across 14 medical and 5 surgical specialties. The impact of AAD on visitation rates and cost of care was evaluated retrospectively using internal data and insurance records. 

Adoption of AAD resulted in a 14% decrease in the cost of care within the first month. By the second month, costs had declined 20%. These savings were attributed to a reduction in emergency department visits and specialist office visits, the latter dropping 74% in the first month. Specialist appointment wait times improved such that the time from a new patient referral to the first face-to-face declined by more than 16%. PCPs rated their satisfaction with the AAD service as 4.3 out of 5, with 5 being excellent.¹

2. Electronic Consultations (eConsults): A Proof of Concept Trial in Australia

This prospective observational study assessed the efficacy of endocrinology eConsults at the Princess Alexandra Hospital in Brisbane, Australia, from November 2020 to May 2021. After each eConsult, both the GP and endocrinologist completed an online questionnaire. The study found that eConsults significantly improved patient outcomes such that 68% of eConsults initiated a new or additional course of treatment and 55% prevented the need for a specialist referral. PCPs also rated the experience positively, with an average eConsult completion time of 14 minutes. Ultimately 97% of the eConsults were rated as excellent by the PCPs.² 

3. Improving Communication Between Primary Care Providers and Specialists

Review results of a recently-implemented eConsult program — Project CORE — from the Children’s Hospital at Dartmouth-Hitchcock. With the goal of enhancing communication between primary care and emergency care specialty care providers, the project reports ninety-percent of eConsults avoided unnecessary face-to-face referral.³

4. A Cost-Effectiveness Analysis of Cardiology eConsults for Medicaid Patients

This study assessed the cost differences between eConsults and face-to-face referrals for Medicaid cardiology patients. A total of 369 Medicaid patients were randomly assigned to either eConsults or face-to-face referrals across seven categories: inpatient, outpatient, emergency department, pharmacy, labs, cardiac procedures, and “all other.” Total cost of care and patient costs were assessed six months following the eConsult or specialist visit.

For those using eConsults, total costs declined by $655 per patient when compared with the face-to-face group. Specifically, costs in the eConsult outpatient cardiac procedures category were reduced by $81 per patient.⁴

5. Comparing Patients’ Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey

Patient experiences with eConsults versus face-to-face referrals were compared through a post-appointment survey conducted at nine U.S. academic medical centers. The survey measured various aspects of satisfaction, including trust in and satisfaction with the PCP, awareness of the consult type, agreement with the decision to seek specialist input, timeliness of care, mode of PCP-patient eConsult communication, satisfaction with the specialist’s recommendations, and future preference for eConsults or referrals. With a 27.6% response rate, the survey garnered 8,087 respondents (88.4% referral; 11.6% eConsult). 

Patients were equally satisfied with specialist recommendations received via eConsults and face-to-face referrals. A positive experience with the PCP was associated with higher satisfaction rates with the specialist. Additionally, 78% of eConsult patients and 32% of referral patients expressed a preference for eConsults in the future.⁵

Conclusion

From significant cost savings for healthcare systems, to increased satisfaction among primary care providers, the benefits of eConsults are undeniable. Patients are also reaping the rewards, with faster access to specialist insights and more personalized care. As the healthcare landscape continues to evolve, eConsults will be a vital tool to streamline processes, bridge gaps in access, and ultimately, deliver better outcomes for everyone involved.

References:

1. Ackerman, S.L., Gleason, N. & Shipman, S.A. Comparing Patients’ Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey. J GEN INTERN MED 35, 1135–1142 (2020). https://doi.org/10.1007/s11606-020-05703-7
2. Russell, Anthony W., Adkins, Peter, et al. Electronic consultations (eConsults): a proof of concept trial in Australia. Intern Med J. 2022 Dec; 52(12):2150-2156. 
3. Children’s Hospital Association. Improving Communication Between Primary Care Providers and Specialists. Feb. 25, 2021. Website: https://www.childrenshospitals.org/news/childrens-hospitals-today/2021/02/improving-communication-between-primary-care-providers-and-specialists
4. Anderson, D., Villagra, V., Coman, E. N., Zlateva, I., Hutchinson, A., Villagra, J., & Olayiwola, J. N. (2018). A cost-effectiveness analysis of cardiology eConsults for Medicaid patients. The American journal of managed care, 24(1), e9–e16.
5. Ackerman, S.L., Gleason, N. & Shipman, S.A. Comparing Patients’ Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey. J GEN INTERN MED 35, 1135–1142 (2020). https://doi.org/10.1007/s11606-020-05703-7