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Alternative to curbside consults: The eConsult. patient safety first!

Posted: Friday, January 4, 2019

By Ed Cladera, MD, AristaMD Medical Director

eConsults as alternative to curbside consults

The practice of curbside consultation is routine for many practicing physicians. However, a brief review on potential shortcomings of this practice is essential to ensure solutions are in place to enable the best possible patient care. An eConsult is an evolved, official form of the curbside consult that addresses many of the inherent issues within these informal exchanges, including missing or incomplete patient information, the lack of access to physical exam findings, and other relevant data and/or lab results.

Literature review demonstrates that approximately one third of the information needs of family physicians or PCPs are fulfilled using informal (or curbside) consults.1,2 Curbside consults refer to a process by which a provider—informally and without documentation—receives information from another provider to assist in management of a patient. There are several criteria for a consultation to be considered a “curbside consultation”, which are explored in more detail within this article.

PCPs self-report obtaining an average of 3.2 curbside consults per week, while subspecialists report receiving approximately 3.6 per week. One feature of managed care has been to better manage the triage of specialist referrals in order to reduce cost of care for healthcare payers. As a result, many PCPs have had to assume greater responsibility for the care of conditions previously considered the within realm of the subspecialist. Thus, it is likely PCPs will increase use of curbside consultations to obtain clinical advice and information in an attempt to maintain quality care while limiting the number of formal referrals.2,3

The downside to unofficial curbsides as method of care planning support include the following considerations:
  • Inaccurate, incomplete or biased clinical information can result from an informal review
    1. Unlike a formal consultation, curbside consults don’t involve a detailed history, physical examination, or review of laboratory and radiographic studies
    2. The time pressure of an immediate response during a curbside has been identified as a source of incomplete and/or erroneous recommendation.3
  • The process is inefficient and cumbersome
    1. Obtaining curbside consults interrupts workflows and disrupts standard processes.3
    2. Delays in patient care are a result from needing to contact specialist, tracking down within facility, awaiting availability, follow up messages, etc.

‘Curbside’ consults are no longer viable due to liability. eConsults enable providers to reliably receive timely, documented input. The eConsult workflow is so much easier and we, as providers, aren’t waiting by the phone or called out of a room when a specialist calls back.

—Dr. Sue Park, Vista Community Clinics (VCC)

  • Lack of documentation is inherent
    1. Without proper documentation, there are often gaps in the patient record regarding why certain treatment pathways were chosen
    2. Additionally, lack of documentation inhibits provision of optimal treatment guidance, as full medical history is not reliably communicated, leaving both provider and specialist potentially liable
  • Access to network is limited and often unreliable
    1. Providers are limited to specialists within their clinic or closed network
    2. These specialists may not be available consistently, and time often limited
Unlike curbside consults, eConsults provide a way for providers to engage in secure, detailed, and documented collaboration in order to obtain specialty care guidance. This approach has numerous beneficial aspects, such as the following:
  • eConsults provide reliable access to a broad network of specialists
    1. eConsult platforms allow providers access to hundreds of specialists within their existing referral workflow
    2. Responses are timely and are received through standardized methods of communication
    3. Providers are able to enter multiple eConsults for a patient, with consistent follow-up
  • Documentation of patient history and specialist responses promotes a thorough assessment of the most complex cases
    1. Whereas traditional curbsides are limited by lack of information, history, and detail, specialists responding to eConsults have access to all relevant clinical information (including lab results, images and medical history)
    2. Because eConsults occur asynchronously, specialists are not constrained by time and are able to thoroughly assess, research, respond, and answer questions from the requesting provider
    3. All eConsults are signed and dated by the consulting specialist and become an official part of the patient record
    4. Chronic conditions and case follow-up can be managed by utilizing eConsults for the same patient over an extended period of time as eConsult history is always accessible
  • The eConsult process is embedded into referral processing workflow
    1. An easy to use, standardized process for providers increases efficiency
    2. Providers no longer need to wait on availability of specialist—with AristaMD’s platform response is guaranteed within 24 hours, the majority being responded to within the same day
  • Providers have increased opportunity to grow knowledge base
    1. The detail and documentation accompanying eConsults allows providers the opportunity to expand their knowledge base over time
    2. eConsults with identified specialists provide expanded access to a specialized team that can be tapped for recommendations on treatment planning or to confirm a suspected diagnosis
    3. Providers are able to reference a database of their eConsults for guidance on future cases

Collaboration between providers is critical, and eConsults are an effective and scalable alternative to traditional curbside consults. Documented, asynchronous eConsults provide enhanced documentation and traceability, ensure detailed specialist feedback, and maximize efficient and appropriate use of provider resources. Lastly, requesting providers are given the rapid feedback they need to deliver the highest quality care to their patients.

Learn more: Enhancing Primary Care Capabilities Through eConsult-Enabled ‘Super PCPs’

References:

1 Gruppen LD, Wolf FM, Van Voorhees CV, Stross JK. Information-seeking strategies and differences among primary care physicians. Mobius 1987; 7:18-26.

2 Ely JW, Burch RJ, Vinson DC. The information needs of family physicians: case specific clinical questions. J Fam Pract 1992; 25:265-9.

3 Bergus, GR, et al. Use of an E-mail Curbside Consultative Service by Family physicians.


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