The effective use of electronic health records (EHRs) can improve the quality of health care and patient safety. Supported by medical transcription companies, providers leverage EHRs to maintain better documentation and file organization. EHRs also help patients with adherence to medication regimens and scheduled appointments while assisting physicians in tracking their treatment protocols (IOM, 2010). Digitizing patient records has also facilitated electronic consultations or “e-consults”-asynchronous, electronic clinician-to-clinician consultations based on data in the EHR. A recent study by researchers at Massachusetts General Hospital (MGH) found that e-consults can streamline and expedite care in allergy and immunology by significantly reducing wait times and need for specialist visits. The study was published online in the Journal of Allergy and Clinical Immunology: In Practice.
According to statistics from the American Academy of Allergy, Asthma & Immunology and the National Institute of Allergy and Infectious Disease, allergic problems in the United States are the sixth-leading common cause of chronic disease. Allergies and autoimmune disorders are complex conditions. They include allergic rhinitis, angioedema, asthma, atopic dermatitis (eczema), autoimmune (e.g., lupus, multiple sclerosis and rheumatoid arthritis), bronchitis, celiac disease, contact dermatitis, chronic cough, food allergy and sensitivity, hives, and immunodeficiency diseases. When diagnosing and treating these conditions, the allergy and immunology team often has to work with other experts to ensure that patients benefit from specialist care.
The researchers looked at data regarding allergy/immunology e-consults provided under the MGH program from August 2016 through July 2018, as well as in-person consults beginning in August 2014. As of January 2019, the MGH e-consult program involves 47 specialty areas, and almost 10,000 e-consults were provided during 2018. Approximately 300 e-consults completed during the study period. Two-thirds of e-consults related to patients with histories of potentially allergic reactions to drugs like penicillin, many in conjunction with a program to evaluate pregnant patients with a history of penicillin allergy. Immunology e-consults could result from patient or provider concerns about frequent infections or abnormal antibody levels.
The study found that e-consults in allergy and immunology can simplify the process of providing proper care, often reducing the need for in-person specialist visits and the time needed to access specialist guidance. The findings are as follows:
- About 60 percent of the 300 e-consults led to recommendations for in-person specialty visits, while 27 percent provided only advice and education to the referring practitioner.
- When the e-consult led to a recommendation for an in-person specialty visit, information from the e-consult improved the productivity of visits by allowing the allergist to be better prepared.
- The educational information that e-consults provided benefited both referring physicians and the patients, often providing reassurance on the appropriateness of a treatment plan.
- Before setting up the e-consult program, the average wait time for an in-person allergist visit was 22.5 days. After the program began, the wait time reduced to 21.0 days.
- Allergists completed e-consults in an average of 11 minutes, and the average turnaround time for the referring provider to receive allergy specialist guidance was less than 24 hours.
For many patients, e-consults avert the need for an in-person visit entirely; and even when an in-person consult is required, the initial e-consult provides valuable information – including additional patient history, previous diagnostic testing and treatment trials – that can make the in-person consult more productive and valuable for the allergist, the referring provider, and the patient.
Earlier studies have also reported that e-consults offer a potential solution to the challenge of enhancing access to specialty care. They offer the primary care physician (PCP) and the specialist a “rapid, direct, and documented communication pathway for consultation”, according to a study published in the Journal of Telemedicine and Telecare in 2015.
These studies show that e-consults are:
- Offer flexibility and are a practical option in a variety of settings
- Are very useful to PCPs by allowing them quickly to determine the best course of action with the guidance of a specialist
- Improve timeliness of specialty consults
- May help avoid the need for a face-to-face visit between the specialist and the patient
- Frees up specialists’ office time to prioritize patients who need more complex care
- Promote cost-effective and convenient care for patients
- Enhance access to and coordination of specialty care across the healthcare system
Medical transcription services have improved the integrity of electronic medical records (EMRs), including record retrieval and management, and other processes. EMRs come with condition- and specialty-specific templates that prompt PCPs to document their expectations for care and determine the next course of action. Specialists who have opted to be in an e-consult program can write an effective e-consult response. This would ensure that the PCP has a record of specific instructions from a specialist (www.news.aamc.org).
However, a key limitation to more widespread use of e-consults is the reliance on EMR systems that may not be shared between specialists and referring physicians, according to Neelam Phadke, the first author of the MGH study.