E-consults can give physicians and patients quicker access to specialists, improve patient experiences, help physicians find joy in medicine, streamline care and eliminate system waste.
By being in contact with primary care, emergency or other physicians, specialists can help guide patients along the continuum of care and help get them to the right place quickly. That is a vast improvement upon what happens too often, which is that patients are handed a piece of paper and expected to navigate the system to get to a specialist on their own.
“I see myself in the future as being more like an air traffic controller—seeing all the patients with fractures and injuries all across the Delaware Valley, where I happen to practice, and help in guiding them and navigating them into our system at the right point of contact to see the right provider at the right time for the right issue,” said pediatric orthopaedic surgeon Alfred Atanda, MD.
Dr. Atanda presented during a recent AMA webinar that delved into how e-consult communications between clinicians work, how these services can be billed, and how organizations can incorporate e-consults.
Care that’s in sync
E-consults can be handled in two ways: synchronously and asynchronously.
With synchronous care, Dr. Atanda consults with other physicians and patients in real time, leveraging technology to interface with outside physicians and patients.
This has eliminated visits where patients come in to have a sling put on, have stitches removed, get a new boot or have a wet cast changed.
“Imagine if they [patients] can stay in their medical home in their primary communities, have somebody on the ground floor with them but infuse my knowledge and my advice and expertise to where it needs to go,” said Dr. Atanda, who is chief of the sports medicine center at Nemours Children’s Hospital in Wilmington and chief of clinician well-being for the hospital.
Asynchronous care is done through messages. For example, Dr. Atanda receives an x-ray or a written summary of the problem. He is able to provide an opinion or guidance to the other physicians within a day or two.
“The PCPs in these situations are often very well-versed in the problem, but they just need a little bit more reassurance, a little bit of guidance,” Dr. Atanda said. “They may not be totally comfortable with just sending someone to therapy or getting an MRI [magnetic resonance image], so it’s very, very convenient and streamlined to just get my knowledge to where it needs to go rather than just sending the patient to see me for a nonoperative problem that can be really handled well and appropriately by the original physician.”
Making the switch
Dr. Atanda has applied these e-consulting tactics as an orthopaedic surgeon. But he noted that there are numerous other specialties such as plastic surgery and cardiology that could use e-consults to benefit patients and physicians.
8 factors to consider
Below are some things that physicians and health care organizations need to consider as they move to implement e-consults, as outlined by Dr. Atanda.
Expect a cultural shift. Specialists typically see patients in the office, order tests or operate. Consulting with other physicians is outside the box of what specialists typically do.
Get appropriate buy-in. Talk to the C-suite executives and let them know this can generate revenue and save system waste.
Determine workflow. Will a physician set aside a half a session a day for e-consults? Will they intersperse it with their regular job? Will they only do e-consults?
Decide which hardware and software will be used. When health data is shared, it must be done in a way that is HIPAA-compliant.
Evaluate startup costs. Will you hire a nurse to triage calls and messages coming in?
Ask how you will you bill for consults. Will you ask for cash payments? Will you bill payers?
Look at specialists’ time and productivity. Consider how this work will affect their traditional role.
Cover the legal bases. Make sure the e-consults meet state and local laws and that physicians are covered by medical liability insurance policies.
Learn more about the AMA Future of Health Immersion Program, which helps physicians, practices and health systems optimize and sustain telehealth and digital care modalities at their organizations.
