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Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis
Michelle S Lee1, Kristin N Ray2, Ateev Mehrotra1
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA Internal Medicine
|May 26, 2018
Summary
Electronic consult (eConsult) systems improve specialty care access but increase primary care practitioners' workload. PCPs value timely input but face challenges with administrative burden and expanded responsibilities.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Digital Health Implementation
Background:
- Safety-net health systems are adopting electronic consult (eConsult) systems to improve specialty care access.
- While eConsults enhance specialty access, their impact on primary care practitioners (PCPs) is not well understood.
Purpose of the Study:
- To understand PCP perceptions of eConsult implementation.
- To assess the effects of eConsults on PCP workflow, specialist access, and patient care.
Main Methods:
- Qualitative interviews with 40 safety-net PCPs in Los Angeles County using an eConsult system.
- Interviews explored perceptions of clinical workflow, specialist access, relationships, and referral decision-making.
Main Results:
- PCPs reported improved timeliness and educational value from eConsults.
- However, PCPs also perceived a shift of specialty care work and increased administrative burden.
- Perceptions varied, with some PCPs valuing the benefits despite the added workload, while others expressed frustration.
Conclusions:
- eConsult systems improve specialty care access but create new challenges for PCPs.
- PCPs exhibit diverging perceptions regarding the workflow changes introduced by eConsults.
- Findings offer insights into potential challenges for future primary care transformation initiatives.