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E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
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e-Consult implementation success: lessons from 5 county-based delivery systems.

Margae Knox1, Elizabeth J Murphy, Timi Leslie

  • 1University of California, Berkeley, School of Public Health, 2121 Berkeley Way West, Room 5435, Berkeley, CA 94720.

The American Journal of Managed Care
|January 18, 2020
PubMed
Summary
This summary is machine-generated.

Successful electronic consultations (e-consults) in public health systems depend on established clinician relationships and integrated electronic health record (EHR) platforms, not just new technology. These factors are key for improving specialty care access.

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Area of Science:

  • Health Services Research
  • Digital Health Implementation
  • Primary Care Transformation

Background:

  • Electronic consultation (e-consult) systems enhance specialty care access by connecting primary care clinicians (PCCs) with specialists.
  • This study examines organizational factors influencing e-consult implementation in five diverse, publicly funded California health systems.

Purpose of the Study:

  • To evaluate the organizational factors critical for successful e-consult implementation in public healthcare settings.
  • To understand the facilitators and barriers to adopting e-consult platforms within resource-constrained environments.

Main Methods:

  • A mixed-methods approach combining semistructured interviews with leaders and analysis of platform operations metrics.
  • Interviews focused on platform selection, EHR integration, stakeholder opinions, and governance, analyzed using the Consolidated Framework for Implementation Research.

Main Results:

  • Three of five systems successfully implemented e-consults, with varying degrees of success (sustained, fragmented, early-stage).
  • Strongest facilitator: existing primary care and specialist relationships. Key technology factor: EHR integration, though add-on platforms also supported expansion.
  • Systems 4 and 5 abandoned implementation due to climate and readiness barriers, highlighting challenges beyond technology.

Conclusions:

  • Successful e-consult adoption in public systems relies on pre-existing clinician relationships and integrated EHR platforms.
  • Findings challenge the notion that technology alone bridges care delivery gaps, emphasizing the importance of foundational relationships and system integration.