Impact of a national specialty e-consultation implementation project on access

Area of Science:

• Health Services Research
• Digital Health Implementation
• Healthcare Access Improvement

Background:

• The Veterans Health Administration (VHA) implemented an electronic consults (e-consults) initiative to enhance access to specialty care.
• This study assesses the early impact of this digital health strategy.

Purpose of the Study:

• To evaluate the initial effects of the VHA's e-consults program on specialty care access.
• To analyze the growth, patient demographics, and potential travel savings associated with e-consults.

Main Methods:

• An observational cohort study design was used, analyzing data from 12 VHA medical centers starting in May 2011, expanded to 122 by December 2013.
• Key metrics included e-consult growth, primary care provider location (VHA medical center vs. community-based outpatient clinic [CBOC]), estimated travel miles saved, and subsequent specialty care utilization.

Main Results:

• Over 11 million consults included 217,014 e-consults (1.93% rate), with highest adoption in endocrinology, hematology, and gastroenterology.
• The proportion of e-consult patients with primary care at a CBOC increased from 28.5% to 45.6% over three years.
• For CBOC patients, e-consults potentially saved over 6.8 million travel miles and $2.8 million in reimbursement costs.

Conclusions:

• E-consult volume grew substantially across various medical and surgical specialties.
• The VHA's e-consults initiative demonstrates a significant potential to alleviate travel burdens and reduce direct travel expenses for patients, particularly those receiving primary care at CBOCs.