Providing Access to Pediatric Specialty Expertise by Extending eConsult Offerings to Internal and External Requesting Providers

Primary Care eConsult Outcomes

Heather Meyers, Director, Virtual Care Innovation & Digital Health Accelerator at Boston Children’s Hospital
Patricia Hanrahan, Sr. Product Manager, Virtual Care at 
Boston Children’s Hospital

Looking at the outcomes from our primary care model, we’ve seen a steady increase since our initial go-live and consistent utilization, most recently seeing that expansion in the most recent months externally, to see broader utilization across that front. Across our specialties, we see dermatology as about 50% of our, all of our eConsults, and always raises a great use case for so and forward technology and eConsults. Our other highest-utilized specialties are endocrinology and gastroenterology. And then from our early outcomes, we’ve seen great success. About 60% of those eConsults can be treated in primary care and locally and about 40% are ultimately recommended for that specialty visit. Overall, great experience and feedback from both the specialists and PCPs, and of all eConsults, about 90% of those are influencing the patient’s care plan, showing that the suggestions are meaningful when they’re being taken back to the patients.

Other feedback we’ve heard from our specialties in particular that are less quantifiable, but show still the value that eConsults have on the specialty are even if the patient is ultimately referred to be seen by that specialty of that, that 40%. A lot of times when the specialist responds, they can help guide the patient to the appropriate clinic for their condition or they can also provide the initial labs that, uh, the patient should complete and bring to their first appointment. Or also providing interim guidance to start on treatment and, um, be able to see how that treatment is reacting once they are ultimately coming to the specialty, which overall just leads to a more efficient first appointment with that specialist too.

Evaluate Practice Performance Metrics for eConsult Programs - Measuring Access to Specialty Care

Evaluate Practice Performance Metrics for eConsult Programs:

Measuring Patient Access to Specialty Care

With considerable time and effort, at-risk practices identify patients at high risk of serious health events. We want to use this same information to develop an eConsult strategy.

To increase patient access to specialty care, consider which specialties have long appointment wait times, higher costs, conditions easily manage by the PCP, or do not require a face-to-face specialist visit. Using eConsults in these situations will drive cost savings, improve outcomes and decrease the risk of:

  • ED use – a costly alternative to a specialist visit.
  • Unscheduled or canceled specialty care appointments.
  • Boomerang appointments to primary care.

Increasing access to specialty care is the goal. Together, we can track and communicate which specialties are most:

  • Needed by the patients you serve
  • Likely to improve outcomes
  • Appropriate for eConsult
  • Valuable to your practice

Identify Specialties with Long Appointment Wait Times

There are many reasons why patients must wait too long to get an appointment with a specialist.

  • Not all specialists accept Medicare and Medicaid.
  • Doctors in many specialty areas are unevenly distributed across the country.
  • Patient referrals are often scheduled by the urgency of the condition.
  • Current patients are prioritized for appointments.

Merritt Hawkins reports that the nationwide average wait time to see an orthopedic surgeon is relatively short – just 16.9 days. However, looking at the average can be misleading.

  • This average is a 48% increase when compared to 2017
  • Getting an appointment with an orthopedist varies tremendously by location – San Diego averages 55 days!

Several factors impact appointment wait times. Not all specialists accept Medicare and Medicaid. Specialists are often clustered in metropolitan areas and unevenly distributed across the county.

Patient’s are less likely to schedule and attend a specialist appointment:

  • When the wait time is extended.
  • Travel distance to the specialist is significant.
  • Cost of the appointment is high — the patient has high-deductible insurance, or the specialist is out-of-network.

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