What Types of Conditions Do You See in Your eConsult Requests?
In this video, Dr. Coggshall, an eConsult Specialist and Dermatologist, discusses how a specialist can benefit a physician and their patient through simple eConsult requests.
Dr. Coggshall
I see a spectrum. I see lesions. I would say that’s the minority, “What is this lesion? Is it cancer? Is it just IC keratosis? Is it something benign? Can you confirm?”. For those consults, it’s really helpful to have the dermatoscopy images. I can confidently say what something is if I have those. Sometimes the images aren’t quite as good and I can’t give as good feedback on those. But I’d say the majority are rashes of some sort, either it’s a known rash like psoriasis or eczema that just hasn’t been responding to treatment. I’ll look at what medications have been tried. I’ll look at the history that’s provided, and I’ll usually, just offer recommendations on that. If it’s very severe, I’ll talk about biologics and I’ll say, at some point, this patient should probably see a dermatologist.
I do see a good number of those. And then sometimes I’ll just see mystery rashes, like really unusual or uncommon things, or things that just have the provider stumped. I saw one very recently that was, a bullous pemphigoid, which the provider didn’t know what it was. It’s very uncommon for dermatologists. We see it frequently, and it’s one of those things that’s tested on the boards and you see it and you know it immediately. So for that consult, I could just say, this is what this is. You don’t have to do a biopsy, you don’t have to do anything else. This is what this is and this is how you treat it. Those happen once in a while, but then there are those where I’m like, I’m not sure what this is. This patient needs a biopsy, and that kind ranges more into the complexity scale, but I would say it’s probably like 70% rashes, 30% more skin cancer lesions, then a little bit of acne. Sometimes I see some acne and just treatment recommendations for that.
Evaluate Practice Performance Metrics for eConsult Programs
Practice performance metrics are in focus whenever a new tool is introduced to improve patient care. In this series, we’ll focus on practice success and patient care when adopting or maintaining an eConsult program. Many of these strategies apply to increasing the adoption of any new technology or program.
There are a few common challenges to effective care and practice success:
- Primary care providers lack the tools and time to help patients navigate care. The average PCP sees between 10-20 patients per day. Patient care is their goal. Adding new technology adds to their workload.
- At the same time, not getting specialist advice for the patient is creating additional work for PCPs. More than 40% of referrals never get scheduled. That means more work for the PCP as patients boomerang back to the primary care setting with the same untreated condition.
- 25% of our healthcare costs are for unnecessary tests and treatments.