Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Top 5 Necessary Factors to Optimize Your eConsult Program

After reading this article, you will be able to identify if your eConsult program has the critical factors necessary for success.

SUMMARY:

  • An eConsult program primarily aids in improving access to various medical specialties and helps primary care providers (PCPs) manage more complex cases.

  • Health Systems have varying levels of success with their eConsult program, since numerous factors must align to have a successful program.

  • Although multiple steps are involved in the development and implementation of an eConsult program, a small number are critical for success.

COMMON PAIN POINTS

  • Leadership turnover is a common problem

  • Inadequate product design within the existing electronic health record (EHR) diminishes engagement, communication, and collaboration

  • Differing concerns with the eConsult program:

    • PCPs' additional workload with eConsult requests

  • Specialists' time factor and reimbursement issues

REVIEW

  • The concept of eConsults is to simplify and efficiently accelerate expert medical specialist availability for PCPs to improve care delivery.

  • eConsult serves as a secure, asynchronous provider-to-provider dialogue for non-urgent clinical questions – often referred to as a “Written Curbside Consult”.

  • An eConsult program should be able to provide specialists with EHR data, provider notes, laboratory values, microbiologic findings, imaging, pathology results, vaccination history and other pertinent data to answer the consult question.

  • The potential advantages of an eConsult include:

    • Reduced time to evaluation

    • Reduced travel for the patient

    • Reduce referrals for simple questions

    • Reduce cost

    • Reduce no-show scheduled visits

  • There are several practical aspects of such a program that need to be considered in the development and implementation of an eConsult program.

Key Determinants of eConsult Success

  • Key Partnerships

    • Prior relationships between PCP’s and specialists are critical factors for success.

    • Clinical champions for each specialty and each clinical site are necessary

    • Health system leadership should serve as the executive sponsors for the project

      • Continuity when health system leadership turnover occurs is of great concern

  • IT Integration

    • To facilitate communication and collaboration, provide access to information and knowledge.

    • Build the eConsult platform within the existing EHR

    • Technology is considered cumbersome

    • Build a secure, robust, and scalable platform

    • 3 possible consult formats:

      • Free-text

      • Directed form with mandatory fields with prompts

      • Existing EHR forms

    • Specialist notification once eConsult placed

    • Can contain decision support and order sets

  • Workflows

    • Develop guidelines for eConsult based on condition and specialty

    • Address how eConsults are assigned

    • Specify a timeframe for a completed response, with notification if not met

    • Clinical resistance to workflow changes

      • PCP’s are concerned with increased workload

    • For PCP form include:

      • Reason for consultation

      • Treatment already provided

      • Suggestions for possible treatment

    • For Specialists form include:

      • Reason for recommendation

      • Suggested possible treatment

      • Suggested tests with response to results

    • Specialists should be able to:

      • Provide answer asynchronously

      • Request additional information before making recommendations

      • Recommend a formal referral

  • Reimbursement

    • Specialists can be:

      • Internal, salaried care providers with greatest concern being the need for more dedicated time to complete the eConsult

      • External, contracted care providers with greatest concern being a financial incentive program

    • Medicare 2025 eConsult CPT codes:

      • 99451 (5 or more minutes): $32.99

      • 99452 (16 to 30 minutes): $33.62

    • Build an incentive payment program

  • Reporting

    • Reporting of specific data to track usage and results

    • Regularly released and reviewed

    • Number of eConsults requested

    • Number of eConsults completed

    • Number of eConsults by specialty

    • Response time

    • Patient demographics

    • eConsult question

    • Time spent by specialist

    • Outcome recommendations

    • Treatment initiated

    • PCP & specialist satisfaction survey

Savvy Approaches

  • Establish relationship with PCP’s and specialists

  • Limit disruption from leadership turnover

  • Develop a multidisciplinary team approach

    • Specialty departments

    • Clinical operations

    • Leadership

    • IT

    • Care content creators

    • Educators

    • QA

  • Develop guidelines on eConsult orders workflows

  • Custom reporting with database

  • Ensure privacy and security

CONCLUSIONS:

  • Numerous factors impact the successful implementation of an eConsult program

  • There may be different roadblocks with different specialties within the same system.

  • The specific factors outlined above are crucial for success and should be addressed.

An optimal eConsult Program requires the alignment of many forces, both internal to the system and external.

One size does not fit all.

However, these key elements above will help programs have the best chance of success.

Do not leave this to chance, - let’s have a brief chat to discuss your unique situation

Erkan Hassan