Primary care physicians initiate completely digital consults with specialists, from within the health system’s electronic health record.
Since October 2016, when it started using a new telehealth technology, ConcertoHealth has seen 73 percent of its new e-consults replace the need for patients to see specialists face-to-face. Further, there has been a 30.3 percent reduction in the health system’s rate of hospital admissions and a 17 percent drop in readmissions.
ConcertoHealth uses a platform from AristaMD that delivers access to specialty care in less than 24 hours. AristaMD was launched by a team of healthcare administrators, clinicians and payers who believed that opportunities existed to deliver higher quality, lower cost care through primary care systems. In addition to AristaMD, there are vendors like RubiconMD that also conduct all-digital e-consults, and there are resources like the Association of American Medical Colleges’ Project CORE that can help providers conduct specialist e-consults. What’s more, many telemedicine vendors can conduct consults with specialists through face-to-face video visits or other means.
“The e-consults provide more timely and actionable feedback for ConcertoHealth care providers,” said Christopher Dodd, MD, regional medical director at ConcertoHealth and a clinical instructor in the department of global health at the University of Washington. “For example, it is extremely difficult to get patients with behavioral health diagnoses to attend specialist consults in Washington,” he explained. “Instead of waiting for a specialist to become available, ConcertoHealth primary care physicians are now empowered to engage a specialist through e-consults within 24 hours to take appropriate action.”
Other areas where ConcertoHealth has seen success with e-consults include endocrine specialists for insulin-dosing regimens as part of diabetic medical management, as well as pain management. Orthopedics also is a significant area for e-consults. Now, when patients report pain, instead of going to the emergency department for X-rays, patients visit ConcertoHealth primary care physicians first, who are then equipped to address these situations by using e-consults with orthopedic specialists.
“While the long-term benefits are avoiding unnecessary admissions and readmissions, the more immediate and tangible impact of e-consults for ConcertoHealth is the ability to avoid unnecessary referrals,” Dodd said. “Timely responses are the most critical component of the primary care physician’s ability to manage their patients.”
The biggest challenge in the whole process for ConcertoHealth was getting clinicians to embrace this technology resource and view e-consults as a tool to help them become a “super primary care physician,” Dodd observed. E-consults help primary care physicians serve as the sole provider to a patient and empower them to leverage the program and understand the nuances of making specialist recommendations for patients, he added. “Today, ConcertoHealth providers actively notify the patient when they use e-consults,” he said.
“Primary care physicians are not afraid to indicate when they don’t have an immediate answer, but are confident in declaring that they have a specialist on-hand through e-consults, and are equipped to provide an answer in a timely fashion.”
An e-consult is a simple process for primary care physicians and patients. ConcertoHealth physicians see a patient during a typical office visit, document the encounter within the electronic health record from eClinicalWorks, log the assessment and treatment plan, and cite the specific reasons for a specialist consult.
“As the primary care physician signs the notes, they select a drop-down tab within the EHR for referrals to e-consult or AristaMD,” Dodd explained. “While this was not a native feature in the EHR, it was not difficult for the EHR to be updated to integrate the e-consults feature.” By flagging an e-consult, AristaMD interfaces with the same EHR and extracts the necessary data to send to the relevant specialist. The primary care physician does not need to be actively logged into the EHR to be notified that a specialist consult has been completed.
“Once the consulting specialist provides feedback, a notification is created in the EHR and providers receive an email that contains a link directly to the AristaMD site,” Dodd explained. “Because the response is available within 24 hours, the primary care physician is able to incorporate recommendations into the patient’s care and treatment plan based on the consult, which significantly reduces any delays in care. During the patient’s follow-up visit with the primary care physician, the provider integrates the recommendations from the specialist into the plan within the EHR, he added.