Tags: technology , coordinated care , uniform high quality , redesigning care

Primary care physicians (PCPs) offer many services, but sometimes a patient presents with a problem that can’t be handled within a typical visit. Usually, these patients have an unusual lab result or a second problem, such as an allergy, preventing them from taking the normal treatment. At this point, patients are typically referred to a specialist, which could mean waiting months for an appointment and more time away from their usual daily activities.

At the specialist appointment, patients retell their medical history and usually are subjected to more tests. The whole process can be long and inefficient, especially for patients who only need quick input from a specialist, but not a full evaluation.

To mitigate delays and connect patients more quickly with quality specialist care, our physicians now have access to a Partners program called eConsults. This program leverages the electronic health record (EHR) platform to connect primary care physicians directly with specialists to streamline and improve care. Using the EHR, PCPs can request an eConsult from a specialist, such as a cardiologist, urologist, or infectious disease physician. The process is similar to sending an email or filling out an online form. And while the idea of doctor to doctor consults is not new—historically it was accomplished with a quick phone call to a colleague—eConsults now provides a formal way to track and manage these types of requests while offering PCPs access to a much larger pool of specialists.

With an easy, accelerated way to get guidance from specialty providers, PCPs, when appropriate, can treat certain patients themselves. For example, a post-partum patient who is breastfeeding and experiencing migraines may not need a full workup with a neurologist. Instead, the neurologist can provide a recommendation to the PCP on how to best treat and manage the patient’s migraines. The PCP can implement this care plan without sending the patient to the neurologist.

eConsults fills in gaps in your knowledge—a quick medication question or interpreting lab results. If a referral isn’t necessary, you can support the care of this patient just in primary care.

Adam Licurse, MD, Associate Medical Director for Partners Center for Population Health

“As a primary care physician, it’s super helpful,” says Adam Licurse, MD, Associate Medical Director for Partners Center for Population Health, Brigham and Women’s Physicians Organization (BWPO), and Medical Director for Virtual Care. “eConsults fills in gaps in your knowledge—a quick medication question or interpreting lab results. If a referral isn’t necessary, you can support the care of this patient just in primary care.”

eConsults free up time on a busy specialist schedule for sicker patients with much more complex care. It’s also more efficient for patients who do need an in-person specialist appointment because lab results and other tests can be ordered prior to the appointment, resulting in a more productive visit.

“If the specialist reviews the question and decided the patient needs to see a specialist, I don’t view that as a failure,” says Amy Flaster, MD, MBA, Assistant Medical Director at Partners Center for Population Health and PCP at Brigham and Women’s Hospital (BWH). “I think it’s great because the specialist gets a heads up and more information than a standard referral. And I can do some additional workup before they go to the specialist office.”

For patients, eConsults are convenient and the collaboration between the PCPs and specialists ultimately ensures that patients get better care.

Since 2012, when the program first launched at Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital, over 9,000 eConsults have been conducted across 40 specialties with an estimated savings of $1.8 million. This has added great value to the care delivered at Partners and helps to foster more collaboration between primary care and specialists.

“eConsults reminds me that population health management, when done right, is really about making care better,” says Jason Wasfy, MD, Assistant Medical Director, Massachusetts General Physicians Organization (MGPO) and Director of Quality and Outcomes Research, Massachusetts General Heart Center. “Very often better care will result in cheaper care, but the real focus we have is on the patient and quality.”

This year the eConsults program will expand from MGH and BWH to several primary care clinicians in our community network. Newton-Wellesley Hospital (NWH) will be the first community hospital to roll-out eConsults starting with infectious disease.

“eConsults ends up fostering really good relationships between specialty and primary care,” says Sandhya Rao, MD, Specialty Programs Medical Director in Partners Center for Population Health and Medical Director for the MGPO. “Not only does it empower primary care physicians to be able to provide more care, it makes specialty care more affordable and more generally accessible to all of our patients.”