ArticleJMIR medical informatics2016
Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System.
Article in JMIR medical informatics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Family Physician-to-Hospital Specialist Electronic Consultation and Access to Hospital Care: A Systematic Review.JAMA network open · 2024Pooled it
- Electronic consultations (E-consults) and their outcomes: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2020Pooled it
- Impact of an Opt-In eConsult Program on Primary Care Demand for Specialty Visits: Stepped-Wedge Cluster Randomized Implementation Study.Journal of general internal medicine · 2020Trial
- Hepatology e-consult responses generated by artificial intelligence demonstrate accuracy but require human oversight.Hepatology communications · 2026Article
- Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system.BMC health services research · 2024Article
- Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study.Journal of medical Internet research · 2024Article
- Evaluating barriers and facilitators to healthcare providers' use of an emergency department electronic referral portal for high-risk children with asthma using the Theoretical Domains Framework.The Journal of asthma : official journal of the Association for the Care of Asthma · 2024Article
- Processes and outcomes from a clinical genetics e-consultation service managed by a primary care physician champion.Genetics in medicine open · 2024Article
- From Clinic to Kitchen to Electronic Health Record: The Background and Process of Building a Culinary Medicine eConsult Service.Journal of multidisciplinary healthcare · 2024Article
- Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2023Article
- Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia.BMC health services research · 2022Article
- The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review.JMIR perioperative medicine · 2022Review
- Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis.JAMA network open · 2020Article
- Cardiology electronic consultations: Efficient and safe, but consultant satisfaction is equivocal.Journal of telemedicine and telecare · 2020Article
- Understanding the Context of High- and Low-Testosterone Prescribing Facilities in the Veterans Health Administration (VHA): a Qualitative Study.Journal of general internal medicine · 2019Article
- Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.Journal of general internal medicine · 2019Article
- Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review.BMJ global health · 2019Article
- Evaluating diverse electronic consultation programs with a common framework.BMC health services research · 2018Article
- Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success.Innovation and entrepreneurship in health · 2018Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElectronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication.
objectiveThe aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system.
methodsData from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults.
resultsA total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e-consults reflected a request for specialist input to a generalist's question in diagnosis or management in the ambulatory setting, we identified creative uses of e-consults, including requests for face-to-face appointments and documentation of pre-operative chart reviews; moreover, 7.00% (360/5141) of the e-consults originated from our sub-acute and chronic care inpatient units. In interviews, requesting providers reported high utility and usability. Specialists recognized the value of e-consults but expressed concerns about additional workload.
conclusionsThe e-consult mechanism is frequently utilized for its initial intended purpose. It has also been adopted for unexpected clinical and administrative uses, developing into a "disruptive innovation" and highlighting existing gaps in mechanisms for provider communication. Further investigation is needed to characterize optimal utilization of e-consults within specialty and the medical center, and what features of the e-consult program, other than volume, represent valid measures of access and quality care.
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