Utilizing eConsult to Improve Access to Specialists from Primary Care

An underlying theme of our transformation initiatives is increasing value for patients, and ensuring they receive the right care at the right place at the right time.

In their recent case study, published in the New England Journal of Medicine’s NEJM Catalyst, Hannah Byrnes-Enoch, MPH, Program Manager, Ambulatory Specialty Care, Jesse Singer, DO, MPH, Assistant Vice President, Care Models and Analytics, and Dr. Dave Chokshi, Chief Population Health Officer, all of OneCity Health, addressed one particular aspect – the challenge facing patients and primary care providers in accessing timely, affordable specialty care.

“Improving our ability to deliver specialist expertise in lower-cost settings for more patients is critical to our mission as a safety-net health system,” said the authors. “Changes in the health care landscape, particularly an increase in the number of uninsured patients, will make access to specialist care in the safety net more challenging for patients.”

Focusing on NYC Health + Hospitals, they identified opportunities for change. These include:

  • Identifying instances where a patient’s needs can be met in the primary care setting in conjunction with a specialist’s input and guidance
  • Increasing access to specialty care based on the urgency of the patient’s need

To make progress, our team sought to determine whether the eConsult concept, sometimes termed eReferral or eCR, could be integrated into NYC Health + Hospitals’ Electronic Health Record (EHR) system. Their goal was to improve provider-to-provider communication and make it easier for primary care providers and specialists to communicate about and co-manage patients when appropriate. Through the EHR, a specialist would review all incoming referrals, responding electronically when appropriate and requesting the patient to be scheduled for a face-to-face visit if needed.

While the full case study details how they executed the pilot, initial results are encouraging. Early data and feedback from pilot clinics show that the eConsult workflow is contributing to improved access to specialty care and clinical recommendations for patients. There were over 6,000 referrals placed in an eConsult and triaged to a specialist in the pilot. Among these, 70 percent were deemed appropriate for an in-person visit and triaged by urgency, while the specialist provided immediate guidance to the primary care provider for the remaining 30 percent.

Dr. Chokshi and his team are continuing to refine the eConsult model to further improve patient communication and scheduling processes. Read the full article to see the lessons learned and other next steps.