Evaluating e-consultation implementations based on use and time-line across various specialties.

Area of Science:

• Health Services Research
• Medical Informatics
• Healthcare Management

Background:

• Electronic consultations (e-consults) offer potential benefits including improved access, enhanced patient and provider satisfaction, and reduced travel expenses.
• Implementation strategies and timelines for e-consults were explored across diabetes, gastroenterology, and neurosurgery specialties at two Veterans Affairs hospitals.

Purpose of the Study:

• To investigate the implementation of e-consults in specialty care areas.
• To analyze the workflow and timeframes associated with e-consults across different medical specialties.

Main Methods:

• Observations and electronic shadowing of patient e-consultations over a thirteen-month period.
• Categorization of the e-consult process into Request, Response, and Follow-up milestones.
• Statistical comparison of time distributions across specialties using the Kolmogorov-Smirnov test.

Main Results:

• A total of 394 e-consults were reviewed across diabetes (n=152), gastroenterology (n=169), and neurosurgery (n=73).
• Overall, 58% of e-consults were completed within 20 days and 68% within 30 days.
• Significant differences in response and follow-up times were observed between diabetes and gastroenterology, and between diabetes and neurosurgery.

Conclusions:

• E-consult utilization and associated timelines can vary significantly depending on the medical specialty.
• Tailored design, implementation, training, and monitoring are essential for optimizing e-consult systems and ensuring prompt access to care.